Provider Demographics
NPI:1083969075
Name:COX, MATTHEW J (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:COX
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:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98586-0395
Mailing Address - Country:US
Mailing Address - Phone:360-875-5757
Mailing Address - Fax:360-875-6021
Practice Address - Street 1:101 WILLAPA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98586-0395
Practice Address - Country:US
Practice Address - Phone:360-875-5757
Practice Address - Fax:360-875-6021
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00060564183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist