Provider Demographics
NPI:1871776252
Name:HERBST, MATTHEW LOWELL (RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LOWELL
Last Name:HERBST
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 1:297 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1407
Mailing Address - Country:US
Mailing Address - Phone:315-255-3867
Mailing Address - Fax:315-255-3867
Practice Address - Street 1:297 GRANT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1407
Practice Address - Country:US
Practice Address - Phone:315-255-3867
Practice Address - Fax:315-255-3867
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist