Provider Demographics
NPI:1932518651
Name:JUSTESEN, MATTHEW COLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:COLE
Last Name:JUSTESEN
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 1:4051 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5801
Mailing Address - Country:US
Mailing Address - Phone:208-373-0024
Mailing Address - Fax:208-373-0784
Practice Address - Street 1:4051 E FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5801
Practice Address - Country:US
Practice Address - Phone:208-373-0024
Practice Address - Fax:208-373-0784
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP7594183500000X
IDE187331835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy