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NPI Code Detail

MEDICARE: ANNA V MATLASHEVSKY PHARM. D

MEDICARE: ANNA V MATLASHEVSKY PHARM. D
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
1183500000XPharmacistP7059ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P7059OTHERIDPHARMACIST LICENSE
2CS36009OTHERIDPHARMACIST CONTROLLED SUBSTANCE REGISTRATION

General Provider Information

NPI Number : 1205242708
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA V MATLASHEVSKY PHARM. D
Provider Business Mailing Address
First Line : 1400 W CHINDEN BLVD
Second Line :
City : MERIDIAN
State : ID
Zip : 83646-5328
Country : US
Telephone Number : 208-893-6033
Fax Number :
Provider Business Practice Location Address
First Line : 1400 W CHINDEN BLVD
Second Line :
City : MERIDIAN
State : ID
Zip : 83646-5328
Country : US
Telephone Number : 208-893-6033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2014
Last Update Date : 07/03/2014

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Directions to “ ANNA V MATLASHEVSKY PHARM. D” Practice Location

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