Provider Demographics
NPI:1972988830
Name:BULL, MATTHEW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:BULL
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 1:5900 TOWNSEND RD
Mailing Address - Street 2:APT 727
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4569
Mailing Address - Country:US
Mailing Address - Phone:386-235-2220
Mailing Address - Fax:
Practice Address - Street 1:410 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5051
Practice Address - Country:US
Practice Address - Phone:904-276-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist