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NPI Code Detail

MEDICARE: MATTHEW WILLIAM UTRUP PHARM.D.

MEDICARE: MATTHEW WILLIAM UTRUP PHARM.D.
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
1183500000XPharmacistS016163AZ

General Provider Information

NPI Number : 1962796755
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW WILLIAM UTRUP PHARM.D.
Provider Business Mailing Address
First Line : 2140 E BASELINE RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85042-6910
Country : US
Telephone Number : 602-281-1120
Fax Number : 602-281-1120
Provider Business Practice Location Address
First Line : 1334 E CHANDLER BLVD
Second Line :
City : PHOENIX
State : AZ
Zip : 85048-6267
Country : US
Telephone Number : 480-283-0119
Fax Number : 480-283-2775
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2011
Last Update Date : 02/17/2021

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