Matt Bourne, PHARMD
Individual provider Active NPI Pharmacist · Berkeley, MO
NPI 1982118881 · NPPES record last updated Nov 30, 2017
Key facts
- NPI
- 1982118881
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 044513 (MO)
- Practice address
- 4700 N Hanley Rd
Berkeley, MO 63134-2700 - Phone
- (314) 475-6000
- NPI assigned
- Nov 30, 2017
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 044513 | MO | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 044513 | MO | Yes |
Addresses
Primary practice location
4700 N Hanley Rd
Berkeley, MO 63134-2700
Mailing address
4700 N Hanley Rd
Berkeley, MO 63134-2700
Phone (314) 475-6000
Other providers in Berkeley, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.