Provider Demographics
NPI:1952446940
Name:COMER, MATTHEW ADAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ADAM
Last Name:COMER
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 1:46 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-2243
Mailing Address - Country:US
Mailing Address - Phone:304-733-3704
Mailing Address - Fax:
Practice Address - Street 1:949 6TH AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2305
Practice Address - Country:US
Practice Address - Phone:304-529-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0004830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist