Provider Demographics
NPI:1801666300
Name:ANDERSON, MATTHEW (RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:ANDERSON
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 1:17437 HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-9433
Mailing Address - Country:US
Mailing Address - Phone:616-402-4494
Mailing Address - Fax:
Practice Address - Street 1:3320 W SHORE DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7753
Practice Address - Country:US
Practice Address - Phone:616-994-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2025-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302416659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist