Provider Demographics
NPI:1538499785
Name:GOH, MATTHEW L (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:L
Last Name:GOH
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 1:15442 N 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-1962
Mailing Address - Country:US
Mailing Address - Phone:623-974-2526
Mailing Address - Fax:623-974-1554
Practice Address - Street 1:15442 N 99TH AVE
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-1962
Practice Address - Country:US
Practice Address - Phone:623-974-2526
Practice Address - Fax:623-974-1554
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist