Active NPI
Matthew Van, PHARMD, RPH
- Pharmacist
- Davenport, IA
National Provider Identifier
1811536519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 23163
- Practice address
- 2200 W Kimberly Rd
Davenport, IA 52806-5369 - Phone
- (563) 391-1543
- NPI assigned
- Dec 27, 2019
- Last updated
- Dec 27, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 23163 | IA | Primary |
Addresses
Primary practice location
2200 W Kimberly Rd
Davenport, IA 52806-5369
Mailing address
4322 Executive Pkwy Apt 418
Westerville, OH 43081-3880
Phone (309) 230-9475
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
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23163 | IA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hy-Vee Inc | Past | Accepting new patients | |
| Hy-Vee Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577404800000",
"number": "1811536519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4322 EXECUTIVE PKWY APT 418",
"city": "WESTERVILLE",
"state": "OH",
"postal_code": "430813880",
"telephone_number": "309-230-9475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 W KIMBERLY RD",
"city": "DAVENPORT",
"state": "IA",
"postal_code": "528065369",
"telephone_number": "563-391-1543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN",
"first_name": "MATTHEW",
"credential": "PHARMD, RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-12-27",
"last_updated": "2019-12-27",
"certification_date": "2019-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IA",
"license": "23163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davenport, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.