MEDICARE: MR. MATTHEW AARON FESSLER

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	051.290351	IL

General Provider Information

NPI Number	:	1932482882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATTHEW AARON FESSLER

Provider Business Mailing Address
First Line	:	15452 OTTERVILLE RD
Second Line	:
City	:	GRAFTON
State	:	IL
Zip	:	62037-2418
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1876 CRAIGSHIRE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4006
Country	:	US
Telephone Number	:	314-485-8600
Fax Number	:	314-485-8600

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

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	01/29/2026

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