1194032045 NPI number — DR. MATTHEW WILLIAM HAAS PHARM.D., PHC

Table of content: DR. MATTHEW WILLIAM HAAS PHARM.D., PHC (NPI 1194032045)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194032045 NPI number — DR. MATTHEW WILLIAM HAAS PHARM.D., PHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAAS
Provider First Name:
MATTHEW
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D., PHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194032045
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1209 UNIVERSITY BLVD NE
Provider Second Line Business Mailing Address:
OUTPATIENT PHARMACY
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87102-1727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-272-0788
Provider Business Mailing Address Fax Number:
505-272-8882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1209 UNIVERSITY BLVD NE
Provider Second Line Business Practice Location Address:
OUTPATIENT PHARMACY
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-272-0788
Provider Business Practice Location Address Fax Number:
505-272-8882
Provider Enumeration Date:
09/13/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  PC00000177 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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