Provider Demographics
NPI:1265726368
Name:MATZ, ADAM DAVID (PHARMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:DAVID
Last Name:MATZ
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 1:9400 STATE ROAD 16
Mailing Address - Street 2:TARGET PHARMACY
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8540
Mailing Address - Country:US
Mailing Address - Phone:608-779-5780
Mailing Address - Fax:608-406-3496
Practice Address - Street 1:9400 STATE ROAD 16
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8540
Practice Address - Country:US
Practice Address - Phone:608-779-5780
Practice Address - Fax:608-406-3496
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2014-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL051293610183500000X
WI15328-40183500000X
IA20847183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist