Provider Demographics
NPI:1063989440
Name:MATICH, MATT (RPH)
Entity type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:MATICH
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 1:13964 WASHITA CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8551
Mailing Address - Country:US
Mailing Address - Phone:317-714-0823
Mailing Address - Fax:
Practice Address - Street 1:13964 WASHITA CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8551
Practice Address - Country:US
Practice Address - Phone:317-714-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023533A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist