MEDICARE: MR. MATTHEW SCOTT GUNN 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	5302027968	MI

General Provider Information

NPI Number	:	1598752305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW SCOTT GUNN RPH

Provider Business Mailing Address
First Line	:	12156 GLENMARK TRL
Second Line	:
City	:	MONTROSE
State	:	MI
Zip	:	48457-9767
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11830 N SAGINAW ST
Second Line	:
City	:	MOUNT MORRIS
State	:	MI
Zip	:	48458-1594
Country	:	US
Telephone Number	:	810-686-2900
Fax Number	:	810-686-8213

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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