Matthew Robert Anderson
Individual provider Active NPI Pharmacist · West Lafayette, IN
NPI 1093624322 · NPPES record last updated Sep 2, 2026
Key facts
- NPI
- 1093624322
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 45024376A (IN)
- Practice address
- 575 Stadium Mall Dr
West Lafayette, IN 47907-2091 - Phone
- (847) 804-6351
- NPI assigned
- Sep 2, 2026
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 45024376A | IN | Yes |
Addresses
Primary practice location
575 Stadium Mall Dr
West Lafayette, IN 47907-2091
Mailing address
712 Franklin LN
Lindenhurst, IL 60046-4985
Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.