Provider Demographics
NPI:1912284597
Name:HIRSCH, MATTHEW J (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:HIRSCH
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 1:99 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2200
Mailing Address - Country:US
Mailing Address - Phone:808-242-7095
Mailing Address - Fax:808-244-9747
Practice Address - Street 1:99 S MARKET ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2200
Practice Address - Country:US
Practice Address - Phone:808-242-7095
Practice Address - Fax:808-244-9747
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPH2849183500000X
CO13427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist