Healthcare Provider Details

I. General information

NPI: 1487290631
Provider Name (Legal Business Name): MATTHEW LAYMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 E COLLEGE AVE
NORMAL IL
61761-2120
US

IV. Provider business mailing address

411 LABRADOR LN
NORMAL IL
61761-5611
US

V. Phone/Fax

Practice location:
  • Phone: 309-452-0839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051293575
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: