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NPI Code Detail

MEDICARE: MR. LESTER ALLAN MATTSON RPH

MEDICARE: MR. LESTER ALLAN MATTSON RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist34503TX

General Provider Information

NPI Number : 1023394004
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LESTER ALLAN MATTSON RPH
Provider Business Mailing Address
First Line : 4501 GUADALUPE ST
Second Line :
City : AUSTIN
State : TX
Zip : 78751-2937
Country : US
Telephone Number : 512-323-6098
Fax Number : 512-323-6735
Provider Business Practice Location Address
First Line : 4501 GUADALUPE ST
Second Line :
City : AUSTIN
State : TX
Zip : 78751-2937
Country : US
Telephone Number : 512-323-6098
Fax Number : 512-323-6735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2011
Last Update Date : 10/23/2011

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