MEDICARE: MATTHEW KITCHEN

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	RP0007648	WV

General Provider Information

NPI Number	:	1619234267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW KITCHEN

Provider Business Mailing Address
First Line	:	369 GEORGE KOSTAS DR
Second Line	:	SUITE 1
City	:	LOGAN
State	:	WV
Zip	:	25601-3493
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	369 GEORGE KOSTAS DR
Second Line	:	SUITE 1
City	:	LOGAN
State	:	WV
Zip	:	25601-3493
Country	:	US
Telephone Number	:	304-962-6117
Fax Number	:

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

Provider Enumeration Date	:	04/20/2012
Last Update Date	:	04/20/2012

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Directions to “ MATTHEW KITCHEN ” Practice Location

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