Provider Demographics
NPI:1659906261
Name:DOHMAN, MATTHEW LEE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LEE
Last Name:DOHMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 MARYLAND AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2511
Mailing Address - Country:US
Mailing Address - Phone:651-774-1005
Mailing Address - Fax:651-776-5117
Practice Address - Street 1:810 MARYLAND AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2511
Practice Address - Country:US
Practice Address - Phone:651-774-1005
Practice Address - Fax:651-776-5117
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN121854OtherSTATE LICENSE