Provider Demographics
NPI:1538564638
Name:LOCK, MATTHEW (PHARM D)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LOCK
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 1:924 CHARLESTON LOOP
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4129
Mailing Address - Country:US
Mailing Address - Phone:334-303-0284
Mailing Address - Fax:
Practice Address - Street 1:1401 HILLCREST RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4032
Practice Address - Country:US
Practice Address - Phone:251-633-7298
Practice Address - Fax:251-633-9930
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19918183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist