Healthcare Provider Details

I. General information

NPI: 1487873840
Provider Name (Legal Business Name): JOHN MATTHEW GUZALLIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N 30TH ST
OMAHA NE
68131-2137
US

IV. Provider business mailing address

3630 N 104TH AVE
OMAHA NE
68134-7102
US

V. Phone/Fax

Practice location:
  • Phone: 402-449-4567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12535
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: