MEDICARE: MICHAEL MATTHEW NINO

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	38303	TX

General Provider Information

NPI Number	:	1154921534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MATTHEW NINO

Provider Business Mailing Address
First Line	:	1004 W OCEAN BLVD
Second Line	:
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-3666
Country	:	US
Telephone Number	:	956-233-1822
Fax Number	:	956-233-1798

Provider Business Practice Location Address
First Line	:	1004 W OCEAN BLVD
Second Line	:
City	:	LOS FRESNOS
State	:	TX
Zip	:	78566-3666
Country	:	US
Telephone Number	:	956-233-1822
Fax Number	:	956-233-1798

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	10/27/2020

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