MEDICARE: DR. MATT TULL

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	1-14219	KS

General Provider Information

NPI Number	:	1891187415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATT TULL

Provider Business Mailing Address
First Line	:	1305 E KANSAS AVE
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5805
Country	:	US
Telephone Number	:	620-275-1957
Fax Number	:	620-272-8218

Provider Business Practice Location Address
First Line	:	1305 E KANSAS AVE
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-5805
Country	:	US
Telephone Number	:	620-275-1957
Fax Number	:	620-272-8218

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

Provider Enumeration Date	:	02/19/2015
Last Update Date	:	02/19/2015

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Directions to “ DR. MATT TULL ” Practice Location

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