Provider Demographics
NPI:1427712587
Name:MACIAS, MATTHEW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:MACIAS
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 1:2626 THROCKMORTON ST APT 1343
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3929
Mailing Address - Country:US
Mailing Address - Phone:915-929-0724
Mailing Address - Fax:
Practice Address - Street 1:810 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-4708
Practice Address - Country:US
Practice Address - Phone:972-641-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69634183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist