MEDICARE: MATTHEW D WEEGE R.PH.

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	11741-40	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376810481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW D WEEGE R.PH.

Provider Business Mailing Address
First Line	:	829 E GREEN BAY AVE
Second Line	:
City	:	SAUKVILLE
State	:	WI
Zip	:	53080-2618
Country	:	US
Telephone Number	:	262-268-9091
Fax Number	:	262-268-9098

Provider Business Practice Location Address
First Line	:	829 E GREEN BAY AVE
Second Line	:
City	:	SAUKVILLE
State	:	WI
Zip	:	53080-2618
Country	:	US
Telephone Number	:	262-268-9091
Fax Number	:	262-268-9098

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

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	11/18/2011

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