Provider Demographics
NPI:1861912560
Name:ANDRZEJEWSKI, MATTHEW D (RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:ANDRZEJEWSKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:D
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1870 E HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2221
Mailing Address - Country:US
Mailing Address - Phone:520-827-0756
Mailing Address - Fax:
Practice Address - Street 1:2702 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1130
Practice Address - Country:US
Practice Address - Phone:602-323-3347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ014075183500000X
AZS014075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist