Provider Demographics
NPI:1689220253
Name:KOVACH, MATHEW STEPHAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:STEPHAN
Last Name:KOVACH
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 1:1006 W CAPULIN TRL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5588
Mailing Address - Country:US
Mailing Address - Phone:440-858-5243
Mailing Address - Fax:
Practice Address - Street 1:3170 S HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-2051
Practice Address - Country:US
Practice Address - Phone:480-279-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist