MEDICARE: MATTHEW EDEN CHRISTIANI PTIC

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	183700000X	Pharmacy Technician	859	AK

General Provider Information

NPI Number	:	1346290186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW EDEN CHRISTIANI PTIC

Provider Business Mailing Address
First Line	:	3056 LEIGHTON ST
Second Line	:	B
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1533
Country	:	US
Telephone Number	:	907-243-0622
Fax Number	:

Provider Business Practice Location Address
First Line	:	3056 LEIGHTON ST
Second Line	:	B
City	:	ANCHORAGE
State	:	AK
Zip	:	99517-1533
Country	:	US
Telephone Number	:	907-243-0622
Fax Number	:	907-257-4687

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	07/08/2007

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