MEDICARE: ANDREW MATULIONIS R.PH.

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	3385	MT

General Provider Information

NPI Number	:	1518391234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW MATULIONIS R.PH.

Provider Business Mailing Address
First Line	:	795 SUNSET BLVD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3699
Country	:	US
Telephone Number	:	406-260-4181
Fax Number	:

Provider Business Practice Location Address
First Line	:	795 SUNSET BLVD
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3699
Country	:	US
Telephone Number	:	406-260-4181
Fax Number	:

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

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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