Provider Demographics
NPI:1154651388
Name:TRAYLOR, MATTHEW A (PHARM D)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
Last Name:TRAYLOR
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 W INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-2602
Mailing Address - Country:US
Mailing Address - Phone:623-247-1014
Mailing Address - Fax:623-247-4642
Practice Address - Street 1:5101 W INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-2602
Practice Address - Country:US
Practice Address - Phone:623-247-1014
Practice Address - Fax:623-247-4642
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ015687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist