Provider Demographics
NPI:1194032045
Name:HAAS, MATTHEW WILLIAM (PHARMD, PHC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WILLIAM
Last Name:HAAS
Suffix:
Gender:M
Credentials:PHARMD, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 UNIVERSITY BLVD NE
Mailing Address - Street 2:OUTPATIENT PHARMACY
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1727
Mailing Address - Country:US
Mailing Address - Phone:505-272-0788
Mailing Address - Fax:505-272-8882
Practice Address - Street 1:1209 UNIVERSITY BLVD NE
Practice Address - Street 2:OUTPATIENT PHARMACY
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1727
Practice Address - Country:US
Practice Address - Phone:505-272-0788
Practice Address - Fax:505-272-8882
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPC000001771835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist