Provider Demographics
NPI:1457650863
Name:WOTRING, MATTHEW WILLIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:WILLIS
Last Name:WOTRING
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 1:4440 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-4309
Mailing Address - Country:US
Mailing Address - Phone:865-523-3762
Mailing Address - Fax:
Practice Address - Street 1:4440 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-4309
Practice Address - Country:US
Practice Address - Phone:865-523-3762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000034393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist