MEDICARE: MATTHEW ALBERT

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
1	183500000X	Pharmacist	1-106218	KS

General Provider Information

NPI Number	:	1093297012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ALBERT

Provider Business Mailing Address
First Line	:	1812 N. BUCKEYE
Second Line	:
City	:	ABILENE
State	:	KS
Zip	:	67410
Country	:	US
Telephone Number	:	785-263-3770
Fax Number	:

Provider Business Practice Location Address
First Line	:	209 W 2ND ST
Second Line	:
City	:	MINNEAPOLIS
State	:	KS
Zip	:	67467-2311
Country	:	US
Telephone Number	:	785-392-2213
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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