Provider Demographics
NPI:1497046122
Name:POYANT, MATTHEW JON (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JON
Last Name:POYANT
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 1:34 ASHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921-7502
Mailing Address - Country:US
Mailing Address - Phone:401-822-3216
Mailing Address - Fax:
Practice Address - Street 1:655 WARREN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1404
Practice Address - Country:US
Practice Address - Phone:401-434-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI03741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist