Individual
MATTHEW VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, RPH
Contact information
Practice address
2200 W KIMBERLY RD, DAVENPORT, IA 52806-5369
(563) 391-1543
Mailing address
4322 EXECUTIVE PKWY APT 418, WESTERVILLE, OH 43081-3880
(309) 230-9475
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
23163
IA
Other
Enumeration date
12/27/2019
Last updated
12/27/2019
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