Provider Demographics
NPI:1508352105
Name:HIX, MATTHEW MARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:MARK
Last Name:HIX
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 1:10 RICHLAND MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6864
Mailing Address - Country:US
Mailing Address - Phone:803-434-6482
Mailing Address - Fax:803-434-6448
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6877
Practice Address - Country:US
Practice Address - Phone:803-434-6482
Practice Address - Fax:803-434-6448
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist