Provider Demographics
NPI:1366073033
Name:MATTHEW, RICHARD A (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:A
Last Name:MATTHEW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33021 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-1800
Mailing Address - Country:US
Mailing Address - Phone:586-293-5012
Mailing Address - Fax:586-415-2230
Practice Address - Street 1:33021 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1800
Practice Address - Country:US
Practice Address - Phone:586-293-5012
Practice Address - Fax:586-415-2230
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025584183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist