Provider Demographics
NPI:1700498441
Name:EHRHARDT, MATTHEW (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:EHRHARDT
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5150
Mailing Address - Country:US
Mailing Address - Phone:618-466-8179
Mailing Address - Fax:618-466-8193
Practice Address - Street 1:2610 STATE ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5150
Practice Address - Country:US
Practice Address - Phone:618-466-8179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist