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General NPI Number Information
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NPI Number | 1568303378
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Entity Type | Individual
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Provider Name | BENJAMIN WYATT CASTRO-MATTHEWS
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Gender | Male
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Dates
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Enumeration Date | 04/03/2026
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 3033 N BROADWAY ST
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City | CHICAGO
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State | IL
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Zip | 60657-5315
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Country | US
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Telephone | 773-883-6141
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Fax | 773-883-6146
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Provider Business Mailing Address
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Address Line | 3526 N PINE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1877
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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 | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number | 049318126
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License Number State | IL
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