Provider Demographics
NPI:1659967842
Name:VOLDENG, MATTHEW N
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:N
Last Name:VOLDENG
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 1:201 TUNBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3735
Mailing Address - Country:US
Mailing Address - Phone:479-721-8370
Mailing Address - Fax:479-271-8164
Practice Address - Street 1:1209 N WALTON BLVD
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4130
Practice Address - Country:US
Practice Address - Phone:479-273-5541
Practice Address - Fax:479-271-8164
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist