Provider Demographics
NPI:1174874523
Name:GILES, MATTHEW BRYANT (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRYANT
Last Name:GILES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 ARDEN CREEK WAY APT 6204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8049
Mailing Address - Country:US
Mailing Address - Phone:304-685-4413
Mailing Address - Fax:
Practice Address - Street 1:1980 RIO HILL CTR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1144
Practice Address - Country:US
Practice Address - Phone:434-978-1661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202211715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist