Provider Demographics
NPI:1679738652
Name:WINDHAM, MATT REEVES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:REEVES
Last Name:WINDHAM
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 1:2021 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5808
Mailing Address - Country:US
Mailing Address - Phone:865-525-4189
Mailing Address - Fax:865-525-9456
Practice Address - Street 1:2021 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5808
Practice Address - Country:US
Practice Address - Phone:865-525-4189
Practice Address - Fax:865-525-9456
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000029615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist