MEDICARE: DR. MATTHEW ALLEN LEVAN 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	70734	CA

General Provider Information

NPI Number	:	1881943207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW ALLEN LEVAN PHARMD

Provider Business Mailing Address
First Line	:	5644 MISSION CENTER RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4328
Country	:	US
Telephone Number	:	619-298-3655
Fax Number	:	619-298-6050

Provider Business Practice Location Address
First Line	:	5644 MISSION CENTER RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4328
Country	:	US
Telephone Number	:	619-298-3655
Fax Number	:	619-298-6050

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

Provider Enumeration Date	:	08/30/2012
Last Update Date	:	11/03/2015

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