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General NPI Number Information
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NPI Number | 1831282557
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Entity Type | Individual
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Provider Name | JOHN T MATEYKA RPH
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 124 MINN AVE N
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City | AITKIN
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State | MN
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Zip | 56431
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Country | US
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Telephone | 218-927-3754
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Fax | 218-927-6349
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Provider Business Mailing Address
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Address Line | 43277 335TH LANE
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City | AITKIN
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State | MN
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Zip | 56431
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Country | US
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Telephone | 218-927-3754
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Fax | 218-927-6349
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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 | 1146714
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License Number State | MN
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