Provider Demographics
NPI:1902233166
Name:SASAKI, MATTHEW A (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:A
Last Name:SASAKI
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 1:4649 LOMA DEL SUR DR APT 1005
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-3355
Mailing Address - Country:US
Mailing Address - Phone:808-542-4332
Mailing Address - Fax:
Practice Address - Street 1:12390 EDGEMERE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4464
Practice Address - Country:US
Practice Address - Phone:915-849-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54032183500000X
HI3546183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist