Matthew Bourquein, PHARMD

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

26029257A Issued in IN

Practice address

1600 E Tipton St
Seymour, IN 47274-3560

Phone

(812) 522-5252

Fax

(812) 522-6152

NPI assigned

Oct 17, 2021

Last updated

Oct 17, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1634428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634428800000",
    "number": "1518620525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 E TIPTON ST",
            "city": "SEYMOUR",
            "state": "IN",
            "postal_code": "472743560",
            "telephone_number": "812-522-5252",
            "fax_number": "812-522-6152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E TIPTON ST",
            "city": "SEYMOUR",
            "state": "IN",
            "postal_code": "472743560",
            "telephone_number": "812-522-5252",
            "fax_number": "812-522-6152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURQUEIN",
        "first_name": "MATTHEW",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-17",
        "last_updated": "2021-10-17",
        "certification_date": "2021-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "IN",
            "license": "26029257A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA PHARMACIST LICENSE",
            "identifier": "26029257A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Mbourqu.s01033@us.wal-mart.com",
            "affiliation": "N",
            "endpointDescription": "Work email address",
            "address_1": "1600 E Tipton St",
            "city": "Seymour",
            "state": "IN",
            "country_code": "US",
            "postal_code": "472743560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dana Kay Bowling, LMHC
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• Diana Louise Brackin, NP
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• Amy Lynne Braman, MPT

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Seymour, IN
• Providers in Seymour, IN by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2021; 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.