Provider Demographics
NPI:1376031146
Name:HOCTOR, MATTHEW RALPH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RALPH
Last Name:HOCTOR
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 1:6821 SE MALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3573
Mailing Address - Country:US
Mailing Address - Phone:518-708-9638
Mailing Address - Fax:
Practice Address - Street 1:1020 WASCO ST STE C
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1159
Practice Address - Country:US
Practice Address - Phone:518-708-9638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016287183500000X
NY0638431835P0018X
OR00162871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist