Provider Demographics
NPI:1073877270
Name:WEISSER, MATTHEW THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:WEISSER
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 1:14218 92ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-8710
Mailing Address - Country:US
Mailing Address - Phone:253-857-7797
Mailing Address - Fax:253-857-7679
Practice Address - Street 1:14218 92ND AVE NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98329-8710
Practice Address - Country:US
Practice Address - Phone:253-857-7797
Practice Address - Fax:253-857-7679
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60024675183500000X
WAPH602919791835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist