Provider Demographics
NPI:1487241410
Name:DAVY, MATTHEW DALE (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DALE
Last Name:DAVY
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 1:100 OPPORTUNITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-5822
Mailing Address - Country:US
Mailing Address - Phone:763-689-0185
Mailing Address - Fax:763-689-0188
Practice Address - Street 1:100 OPPORTUNITY BLVD N
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-5822
Practice Address - Country:US
Practice Address - Phone:763-689-0185
Practice Address - Fax:763-689-0188
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN123850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist