Provider Demographics
NPI:1124378120
Name:MATTHEWS, CECIL DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:DAVID
Last Name:MATTHEWS
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 1:14664 RED RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5623
Mailing Address - Country:US
Mailing Address - Phone:859-457-2304
Mailing Address - Fax:361-221-0794
Practice Address - Street 1:1010 WEST AVE B
Practice Address - Street 2:OEE
Practice Address - City:KINGSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78363
Practice Address - Country:US
Practice Address - Phone:361-221-0660
Practice Address - Fax:361-221-0794
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX287671835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric