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NPI Code Detail

MEDICARE: MR. JAMES MATERN RPH

MEDICARE: MR. JAMES MATERN RPH
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
1183500000XPharmacist151177-1701UT

General Provider Information

NPI Number : 1821009192
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES MATERN RPH
Provider Business Mailing Address
First Line : PO BOX 1016
Second Line :
City : DRAPER
State : UT
Zip : 84020-1016
Country : US
Telephone Number : 801-913-3980
Fax Number :
Provider Business Practice Location Address
First Line : 7495 S STATE ST
Second Line :
City : MIDVALE
State : UT
Zip : 84047-2013
Country : US
Telephone Number : 801-561-4695
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2006
Last Update Date : 07/08/2007

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