Provider Demographics
NPI:1144805102
Name:GAITHER, MATTHEW STEWART (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEWART
Last Name:GAITHER
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 1:4003 N LOOP 1604 W APT 4104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1782
Mailing Address - Country:US
Mailing Address - Phone:419-283-3194
Mailing Address - Fax:
Practice Address - Street 1:4331 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2101
Practice Address - Country:US
Practice Address - Phone:210-599-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57728183500000X
FL59059183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist