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General NPI Number Information
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NPI Number | 1073100756
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Entity Type | Individual
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Provider Name | MATTHEW MARIAN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 12/29/2020
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 245 E 5TH ST
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City | EUREKA
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State | MO
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Zip | 63025-1223
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Country | US
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Telephone | 636-938-4102
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Fax |
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Provider Business Mailing Address
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Address Line | 385 GENOA DR
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City | BALLWIN
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State | MO
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Zip | 63021-6407
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2019000452
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License Number State | MO
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