Provider Demographics
NPI:1154542777
Name:ANDREWS, MATTHEW ROBERT (DOCTOR OF PHARMACY)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 WILSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-8434
Mailing Address - Country:US
Mailing Address - Phone:502-407-7465
Mailing Address - Fax:
Practice Address - Street 1:10216 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-3616
Practice Address - Country:US
Practice Address - Phone:502-267-7453
Practice Address - Fax:502-267-7455
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY013767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY27-1403066OtherEIN