Provider Demographics
NPI:1760704365
Name:GILBERT, MATTHEW R (CPHT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:GILBERT
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:DANIELSON
Mailing Address - State:CT
Mailing Address - Zip Code:06239-2917
Mailing Address - Country:US
Mailing Address - Phone:860-774-3214
Mailing Address - Fax:860-774-2426
Practice Address - Street 1:42 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:DANIELSON
Practice Address - State:CT
Practice Address - Zip Code:06239-2917
Practice Address - Country:US
Practice Address - Phone:860-774-3214
Practice Address - Fax:860-774-2426
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006568183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician