Provider Demographics
NPI:1720100332
Name:SMITH, MATTHEW (RPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:SMITH
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 1:1701 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-5115
Mailing Address - Country:US
Mailing Address - Phone:813-786-2062
Mailing Address - Fax:813-241-2671
Practice Address - Street 1:5910 BENJAMIN CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5240
Practice Address - Country:US
Practice Address - Phone:813-887-4100
Practice Address - Fax:813-887-4150
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist