MEDICARE: MATTHEW STEVEN HAINTZ

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	060899	NY

General Provider Information

NPI Number	:	1306222831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW STEVEN HAINTZ

Provider Business Mailing Address
First Line	:	5278 SOUTHWESTERN BLVD
Second Line	:	UNIT 505
City	:	HAMBURG
State	:	NY
Zip	:	14075-8000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 CENTRAL AVE
Second Line	:
City	:	SILVER CREEK
State	:	NY
Zip	:	14136-1339
Country	:	US
Telephone Number	:	716-934-3980
Fax Number	:

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

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	08/06/2015

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