Provider Demographics
NPI:1871808436
Name:MATAS, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MATAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9839 E REDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3837
Mailing Address - Country:US
Mailing Address - Phone:480-219-5058
Mailing Address - Fax:
Practice Address - Street 1:3420 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5624
Practice Address - Country:US
Practice Address - Phone:480-941-0915
Practice Address - Fax:480-941-5094
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist