Provider Demographics
NPI:1629445424
Name:FLAHERTY, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FLAHERTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-6407
Mailing Address - Country:US
Mailing Address - Phone:516-334-5908
Mailing Address - Fax:
Practice Address - Street 1:829B CARMAN AVE
Practice Address - Street 2:289B CARMAN AVENUE
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6429
Practice Address - Country:US
Practice Address - Phone:516-333-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist