MEDICARE: MATTHEW RYAN RETTIG PHARMD

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	20666	NC

General Provider Information

NPI Number	:	1558667675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW RYAN RETTIG PHARMD

Provider Business Mailing Address
First Line	:	7134 ROCKRIDGE LN
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28306-9744
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 OWEN DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3432
Country	:	US
Telephone Number	:	910-484-7183
Fax Number	:

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

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	02/08/2011

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