MEDICARE: MATTHEW JAMES PAUL 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	12012-40	WI

General Provider Information

NPI Number	:	1558615476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW JAMES PAUL RPH

Provider Business Mailing Address
First Line	:	N30W7000 LINCOLN BLVD
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-2255
Country	:	US
Telephone Number	:	262-377-0517
Fax Number	:

Provider Business Practice Location Address
First Line	:	N54W6135 MILL ST STE 300
Second Line	:
City	:	CEDARBURG
State	:	WI
Zip	:	53012-2050
Country	:	US
Telephone Number	:	262-375-0010
Fax Number	:

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

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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