Provider Demographics
NPI:1881943207
Name:LEVAN, MATTHEW ALLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:LEVAN
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 1:5644 MISSION CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4328
Mailing Address - Country:US
Mailing Address - Phone:619-298-3655
Mailing Address - Fax:619-298-6050
Practice Address - Street 1:5644 MISSION CENTER RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4328
Practice Address - Country:US
Practice Address - Phone:619-298-3655
Practice Address - Fax:619-298-6050
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70734183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist