MEDICARE: KARILYN MATSON PHARMD

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	5872655-1701	UT

General Provider Information

NPI Number	:	1215254370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARILYN MATSON PHARMD

Provider Business Mailing Address
First Line	:	2545 E 3210 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-8410
Country	:	US
Telephone Number	:	801-860-4999
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 E 3210 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2700
Country	:	US
Telephone Number	:	801-860-4999
Fax Number	:

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

Provider Enumeration Date	:	04/29/2010
Last Update Date	:	12/06/2012

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