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General NPI Number Information
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NPI Number | 1578193744
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Entity Type | Individual
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Provider Name | MATTHEW EUGENE BANTZ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 01/18/2020
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Provider Practice Location Address
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Address Line | 6901 W EDGERTON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53220-4420
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Country | US
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Telephone | 414-421-8401
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Fax | 414-855-0748
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Provider Business Mailing Address
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Address Line | 6901 W EDGERTON AVE
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City | MILWAUKEE
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State | WI
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Zip | 53220-4420
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Country | US
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Telephone | 414-421-8401
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Fax | 414-855-0748
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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 | 17697
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 1-106313
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.021720
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PH236166
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302043341
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23906
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License Number State | MD
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Taxonomy #7
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | T-15141
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License Number State | MS
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Taxonomy #8
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 14885
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License Number State | NE
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Taxonomy #9
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16880
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License Number State | OK
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Taxonomy #10
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 59136
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License Number State | TX
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Taxonomy #11
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 033.0130667
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License Number State | VT
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Taxonomy #12
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RP0008529
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License Number State | WV
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Taxonomy #13
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16320
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License Number State | WI
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