Individual provider Active NPI

Matthew E Likovich

  • Pharmacist
  • Colorado Springs, CO
National Provider Identifier
1205110608
Registry record updated Oct 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
18916 Issued in CO
Practice address
5755 Constitution Ave
Colorado Springs, CO 80915-1220
Phone
(719) 591-9929
NPI assigned
Oct 4, 2011
Last updated
Oct 4, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 18916 CO Primary

Addresses

Primary practice location

5755 Constitution Ave
Colorado Springs, CO 80915-1220

Mailing address

5755 Constitution Ave
Colorado Springs, CO 80915-1220

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
18916COMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1205110608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5755 CONSTITUTION AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809151220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5755 CONSTITUTION AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809151220",
            "telephone_number": "719-591-9929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIKOVICH",
        "first_name": "MATTHEW",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-04",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "18916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.