Provider Demographics
NPI:1548716053
Name:MATSUMURA, GREGORY PHILIP (PHARMD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:PHILIP
Last Name:MATSUMURA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 ARCHGLEN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1734
Mailing Address - Country:US
Mailing Address - Phone:408-833-4676
Mailing Address - Fax:
Practice Address - Street 1:480 ARCHGLEN WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1734
Practice Address - Country:US
Practice Address - Phone:408-833-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist