MEDICARE: DR. MATTHEW J WITRY 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	20831	IA

General Provider Information

NPI Number	:	1831405471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW J WITRY PHARMD

Provider Business Mailing Address
First Line	:	816 DOVER ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-5226
Country	:	US
Telephone Number	:	319-330-6105
Fax Number	:

Provider Business Practice Location Address
First Line	:	816 DOVER ST
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52245-5226
Country	:	US
Telephone Number	:	319-330-6105
Fax Number	:

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

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	08/20/2010

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