Provider Demographics
NPI:1235547381
Name:ALEXANDER, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 TOWN CENTER PLACE
Mailing Address - Street 2:APT 310
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-5703
Mailing Address - Country:US
Mailing Address - Phone:419-889-7303
Mailing Address - Fax:
Practice Address - Street 1:487 TOWN CENTER PL
Practice Address - Street 2:APT 310
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7973
Practice Address - Country:US
Practice Address - Phone:419-889-7303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist