Provider Demographics
NPI:1205045895
Name:CROSS, MATTHEW G (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:G
Last Name:CROSS
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 1:2518 N BRIGHTON PL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2715
Mailing Address - Country:US
Mailing Address - Phone:847-641-0052
Mailing Address - Fax:
Practice Address - Street 1:4186 IL ROUTE 83
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-9563
Practice Address - Country:US
Practice Address - Phone:847-478-5465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-040329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist