Provider Demographics
NPI:1932292406
Name:RHOTEN, MATTHEW EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:EDWARD
Last Name:RHOTEN
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 1:225 ROCKY MT. DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536
Mailing Address - Country:US
Mailing Address - Phone:301-895-4604
Mailing Address - Fax:
Practice Address - Street 1:20 NORTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550
Practice Address - Country:US
Practice Address - Phone:301-334-2197
Practice Address - Fax:301-334-3577
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2107642OtherNAPB(NCPSP) #
WV0142450000Medicaid
MD1356398903OtherPHARMACY NPI #
MD5316560001Medicare NSC