Provider Demographics
NPI:1538514781
Name:KINCAID, MATTHEW RUSSELL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RUSSELL
Last Name:KINCAID
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 1:3265 SMOOT AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-7602
Mailing Address - Country:US
Mailing Address - Phone:304-369-9074
Mailing Address - Fax:304-369-9087
Practice Address - Street 1:3265 SMOOT AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-7602
Practice Address - Country:US
Practice Address - Phone:304-369-9074
Practice Address - Fax:304-369-9087
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV7325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist