MEDICARE: DR. MATTHEW W WARREN PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	19788	NC

General Provider Information

NPI Number	:	1083863443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW W WARREN PHARMD

Provider Business Mailing Address
First Line	:	1194 WYKE RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4259
Country	:	US
Telephone Number	:	704-482-4457
Fax Number	:	704-487-5427

Provider Business Practice Location Address
First Line	:	1194 WYKE RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4259
Country	:	US
Telephone Number	:	704-482-4457
Fax Number	:	704-487-5427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	11/28/2017

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