Provider Demographics
NPI:1861970816
Name:MCNITT, MATTHEW CHARLES (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CHARLES
Last Name:MCNITT
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 1:4062 W REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:BATTLEFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65619-7108
Mailing Address - Country:US
Mailing Address - Phone:417-730-1456
Mailing Address - Fax:
Practice Address - Street 1:1173 E HINES ST
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738
Practice Address - Country:US
Practice Address - Phone:417-735-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist