Provider Demographics
NPI:1699801449
Name:KUEBRICH, MATTHEW RICHARD SR (RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RICHARD
Last Name:KUEBRICH
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 STAINFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-9529
Mailing Address - Country:US
Mailing Address - Phone:630-552-8950
Mailing Address - Fax:
Practice Address - Street 1:142 INDIAN SPRINGS DR
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1902
Practice Address - Country:US
Practice Address - Phone:815-786-8402
Practice Address - Fax:815-786-2814
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist