Provider Demographics
NPI:1649998428
Name:MATZ, JOEL
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:MATZ
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 1:4645 JUNEAU LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-3402
Mailing Address - Country:US
Mailing Address - Phone:612-770-0035
Mailing Address - Fax:
Practice Address - Street 1:1431 BEAM AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1064
Practice Address - Country:US
Practice Address - Phone:612-486-1747
Practice Address - Fax:612-486-1744
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN117048183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist