Provider Demographics
NPI:1700292919
Name:BROOME, MATTHEW DONOVAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DONOVAN
Last Name:BROOME
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 1:1601 SANDIFER BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0905
Mailing Address - Country:US
Mailing Address - Phone:864-885-0889
Mailing Address - Fax:803-482-6533
Practice Address - Street 1:6330 RICHBURG RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:SC
Practice Address - Zip Code:29055-8916
Practice Address - Country:US
Practice Address - Phone:803-374-2480
Practice Address - Fax:803-482-6533
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist