MEDICARE: JARED THOMAS MATTHEWS 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	2008021310	MO

General Provider Information

NPI Number	:	1295052694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED THOMAS MATTHEWS PHARMD

Provider Business Mailing Address
First Line	:	1433 S SAM HOUSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483-2131
Country	:	US
Telephone Number	:	417-967-4521
Fax Number	:	417-967-3598

Provider Business Practice Location Address
First Line	:	1433 S SAM HOUSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483-2131
Country	:	US
Telephone Number	:	417-967-4521
Fax Number	:	417-967-3598

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

Provider Enumeration Date	:	04/23/2010
Last Update Date	:	04/23/2010

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