Provider Demographics
NPI:1750533139
Name:MATTHEWS, DEIDRA MICHELLE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:MICHELLE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:DEIDRA
Other - Middle Name:MATTHEWS
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2659 S NC 127 HWY
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-9129
Mailing Address - Country:US
Mailing Address - Phone:828-294-7056
Mailing Address - Fax:828-294-0125
Practice Address - Street 1:2659 S NC 127 HWY
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9129
Practice Address - Country:US
Practice Address - Phone:828-294-7056
Practice Address - Fax:828-294-0125
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist