Provider Demographics
NPI:1821207515
Name:STRAYER, W MATTHEW (PHARM D, R PH)
Entity Type:Individual
Prefix:MR
First Name:W MATTHEW
Middle Name:
Last Name:STRAYER
Suffix:
Gender:M
Credentials:PHARM D, R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5401
Mailing Address - Country:US
Mailing Address - Phone:319-272-7600
Mailing Address - Fax:319-272-7597
Practice Address - Street 1:601 HIGHWAY 218 N
Practice Address - Street 2:
Practice Address - City:LA PORTE CITY
Practice Address - State:IA
Practice Address - Zip Code:50651-1012
Practice Address - Country:US
Practice Address - Phone:319-342-3620
Practice Address - Fax:319-342-3617
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA8383Medicaid
IA8409Medicaid
IA8375Medicaid