Provider Demographics
NPI:1275026189
Name:BARTLEY, MATTHEW CLAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CLAY
Last Name:BARTLEY
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 1:1820 HAIRSTON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-3225
Mailing Address - Country:US
Mailing Address - Phone:501-514-4477
Mailing Address - Fax:
Practice Address - Street 1:501 ELSINGER BLVD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4717
Practice Address - Country:US
Practice Address - Phone:501-328-5316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD14512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist