Provider Demographics
NPI:1831405471
Name:WITRY, MATTHEW J (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:J
Last Name:WITRY
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 1:816 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-5226
Mailing Address - Country:US
Mailing Address - Phone:319-330-6105
Mailing Address - Fax:
Practice Address - Street 1:816 DOVER ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-5226
Practice Address - Country:US
Practice Address - Phone:319-330-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist