Provider Demographics
NPI:1083861199
Name:CHRISTIANSON, MATTHEW ALAN
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALAN
Last Name:CHRISTIANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3163 SE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056
Mailing Address - Country:US
Mailing Address - Phone:425-235-7430
Mailing Address - Fax:
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:SUITE 110
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166
Practice Address - Country:US
Practice Address - Phone:206-988-5785
Practice Address - Fax:206-901-8414
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000410221835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology