Provider Demographics
NPI:1477686897
Name:MATTHEWS, TIMOTHY G (RPH)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:G
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-3746
Mailing Address - Country:US
Mailing Address - Phone:336-756-7855
Mailing Address - Fax:
Practice Address - Street 1:901 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-3746
Practice Address - Country:US
Practice Address - Phone:336-756-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist