Provider Demographics
NPI:1801189188
Name:SMITH, MATTHEW THOMAS (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THOMAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 YAKIMA VALLEY HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944
Mailing Address - Country:US
Mailing Address - Phone:509-839-2711
Mailing Address - Fax:509-839-4768
Practice Address - Street 1:2010 YAKIMA VALLEY HWY
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1288
Practice Address - Country:US
Practice Address - Phone:509-839-2711
Practice Address - Fax:509-839-4768
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60134853183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPHARMACIST183500000XMedicaid