MATTHEW MILES MACK (NPI# 1205182094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205182094 |
| Entity Type | Individual |
| Full Name | MATTHEW MILES MACK |
| Credential | PHARM.D |
| Practice Address |
3204 Peach Orchard Rd Augusta GA 30906-4862 |
| Practice Telephone | 7067967240 |
| Practice Fax Number | 7067967542 |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2019-02-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | RPH026672 | GA | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629289541 | Matthew P Mack | Dentist | 1420 Dickerson St, Newark, OH 43055-1844 | 2007-05-24 |
| 1770506958 | Matthew D Mack | General Practice | 340 Arnett Blvd, Rochester, NY 14619-1147 | 2006-07-26 |
| Street Address |
3204 PEACH ORCHARD RD |
| City | AUGUSTA |
| State | GA |
| Zip Code | 30906-4862 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851306062 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2006-07-29 |
| 1346855988 | Marcus Brown | Pharmacist | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2020-09-10 |
| 1073921680 | Samantha Burke | Pharmacist | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2014-07-28 |
| 1932531308 | Maryanna Durden Jones | Pharmacist | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2013-08-07 |
| 1962843169 | David Hautman Jones | Pharmacist | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2013-07-16 |
| 1568802023 | Nathaniel Steven Swanson | Pharmacist | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2013-06-28 |
| 1356687172 | David Yong Kho | Pharmacist | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2012-12-26 |
| 1790060655 | Monica Lystra Bayley | Pharmacist | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2011-10-11 |
| 1669754362 | Ahmed A. Elmarakby | Pharmacist | 3204 Peach Orchard Rd, Walgreens Pharmacy, Augusta, GA 30906-4862 | 2011-09-19 |
| 1083996995 | Ravikanth Pasala | Pharmacist | 3204 Peach Orchard Rd, Augusta, GA 30906-4862 | 2011-09-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255969432 | Barton Chapel Dental Group, LLC | Dentist | 2755 Barton Chapel Road, Augusta, GA 30906 | 2020-04-01 |
| 1255897419 | Pediatric Mobility Innovations | Durable Medical Equipment & Medical Supplies | 3114 Augusta Tech Drive Suite 404, Augusta, GA 30906 | 2019-02-13 |
| 1023539731 | Kristy Lee Gibbs | Registered Nurse | 3421 Mike Padgett Hwy Bldg C, Augusta, GA 30906 | 2017-07-03 |
| 1194186031 | Clifton Nane Williams | Counselor | 3230 Hampton Circle, Augusta, GA 30906 | 2016-03-18 |
| 1376929661 | Catherine A. Ganzy | Social Worker | 3405 Mike Padgett Highway; Building 201, East Central Regional Hosptial, Augusta, GA 30906 | 2015-08-10 |
| 1962810358 | Fatemeh Azadeh Paziraei | Dentist | 1631 Gordon Highway, Augusta Smiles Youth Dentistry, Augusta, GA 30906 | 2014-07-29 |
| 1568809770 | Brandon Jennings | Occupational Therapy Assistant | 2388 Old Mcduffie Rd, Augusta, GA 30906 | 2013-05-29 |
| 1811266646 | Eddie P Johnson IIi, Dmd, PC | Preferred Provider Organization | 2755 Barton Chapel Rd, Augusta, GA 30906 | 2011-12-23 |
| 1366739021 | Kerensa A Cooks | Registered Nurse | 3421 Mike Padgett Highway, Serenity Behavioral Health Systems, Augusta, GA 30906 | 2011-07-01 |
| 1265737423 | Pidcock Chiropractic, Inc. | Chiropractor | 3028 Peach Orchard Rd., Augusta, GA 30906 | 2011-01-20 |
| Find all providers in zip 30906 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114534203 | Hyun Kim | Pharmacist | 1504 Bowdoin Dr, Augusta, GA 30909-4510 | 2020-09-23 |
| 1902363385 | Mary D Jodon | Pharmacist | 3338 Wrightsboro Rd., Augusta, GA 30909 | 2019-02-21 |
| 1760958300 | Keith Aloysius Wagner | Pharmacist | 950 15th St Rm 1c-104c, Augusta, GA 30901-2608 | 2018-10-22 |
| 1134600075 | Judah David Abernathy | Pharmacist | 2505 Windsor Spring Rd, Augusta, GA 30906-4642 | 2018-08-28 |
| 1336627785 | Tiffany M Bricker | Pharmacist | 165 Capitol St, Augusta, ME 04330-6232 | 2018-07-29 |
| 1457851842 | Heba Ahmed | Pharmacist | 912 15th Street, Augusta, GA 30904 | 2018-02-13 |
| 1407372444 | Kali Lauren Taylor | Pharmacist | 509 State Street, Augusta, KS 67010 | 2017-08-22 |
| 1851829345 | Christopher Hearon | Pharmacist | 2803 Wrightsboro Rd Ste 17, Augusta, GA 30909-3917 | 2017-05-26 |
| 1669914032 | Brandon Michael Williams | Pharmacist | 2206 Brechin Ln, Augusta, GA 30909-6910 | 2016-11-16 |
| 1073068755 | Seoyeon Lee | Pharmacist | 536 Walden Hills Ct, Augusta, GA 30909-0225 | 2016-08-23 |
| Find all providers in AUGUSTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.