Provider Demographics
NPI:1225698442
Name:MATAS, ALEX JAVIER (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:JAVIER
Last Name:MATAS
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 1:2600 HILLSBORO PIKE APT 343
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5630
Mailing Address - Country:US
Mailing Address - Phone:865-274-2999
Mailing Address - Fax:
Practice Address - Street 1:198 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2520
Practice Address - Country:US
Practice Address - Phone:615-264-3583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist