Provider Demographics
NPI:1710468269
Name:HARTWIG, MATTHEW STEVEN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEVEN
Last Name:HARTWIG
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 1:19 SW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-8388
Mailing Address - Country:US
Mailing Address - Phone:952-412-3940
Mailing Address - Fax:
Practice Address - Street 1:201 E SAMPLE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3502
Practice Address - Country:US
Practice Address - Phone:954-786-6823
Practice Address - Fax:954-786-6647
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS535141835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist