Provider Demographics
NPI:1205150968
Name:CARROLL, MATTHEW ROBERT (RPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:CARROLL
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 1:835 SOLOMONS ISLAND RD N
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3912
Mailing Address - Country:US
Mailing Address - Phone:410-535-2132
Mailing Address - Fax:410-535-5710
Practice Address - Street 1:835 SOLOMONS ISLAND RD N
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3912
Practice Address - Country:US
Practice Address - Phone:410-535-2132
Practice Address - Fax:410-535-5710
Is Sole Proprietor?:No
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11092183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist