MEDICARE: MR. STEVEN NICHOLAS MATSUKAS RPH

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	0202009748	VA

General Provider Information

NPI Number	:	1538137617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN NICHOLAS MATSUKAS RPH

Provider Business Mailing Address
First Line	:	1829 FOXSTONE DR
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2169
Country	:	US
Telephone Number	:	703-242-8013
Fax Number	:	703-938-2314

Provider Business Practice Location Address
First Line	:	1829 FOXSTONE DR
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22182-2169
Country	:	US
Telephone Number	:	703-242-8013
Fax Number	:	703-938-2314

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/08/2007

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