Provider Demographics
NPI:1871888776
Name:ROWLES, MATT WENDEL (PHARMD)
Entity type:Individual
Prefix:MR
First Name:MATT
Middle Name:WENDEL
Last Name:ROWLES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2199 HIGHWAY 36 E
Mailing Address - Street 2:T1185
Mailing Address - City:NORTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2215
Mailing Address - Country:US
Mailing Address - Phone:651-779-6341
Mailing Address - Fax:651-779-6341
Practice Address - Street 1:2199 HIGHWAY 36 E
Practice Address - Street 2:T1185
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-2215
Practice Address - Country:US
Practice Address - Phone:651-779-6341
Practice Address - Fax:651-779-6341
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist