Matthew Disharoon
Individual provider Active NPI Pharmacist · Lavonia, GA
NPI 1295150332 · NPPES record last updated Feb 26, 2014
Key facts
- NPI
- 1295150332
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH027295 (GA)
- Practice address
- 13387 Jones St
Lavonia, GA 30553-1164 - Phone
- (706) 356-4153
- NPI assigned
- Feb 26, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH027295 | GA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH027295 | GA | Yes |
Addresses
Primary practice location
13387 Jones St
Lavonia, GA 30553-1164
Mailing address
243 Seagraves Dr
Athens, GA 30605-2454
Other providers in Lavonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.