Provider Demographics
NPI:1336974187
Name:MENARD, MATTHEW ROBERT (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ROBERT
Last Name:MENARD
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 1:25 RICE CORNER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01506-1804
Mailing Address - Country:US
Mailing Address - Phone:508-450-4078
Mailing Address - Fax:
Practice Address - Street 1:314 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-2902
Practice Address - Country:US
Practice Address - Phone:978-632-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH997235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist