Provider Demographics
NPI:1255926747
Name:PERKINS, MATTHEW CLIFTON (CPHT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:CLIFTON
Last Name:PERKINS
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2237
Mailing Address - Country:US
Mailing Address - Phone:978-809-1983
Mailing Address - Fax:
Practice Address - Street 1:189 NORTH AVE
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-2237
Practice Address - Country:US
Practice Address - Phone:978-809-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3342333600000X
MAPT17569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA183500000XMedicaid