Provider Demographics
NPI:1497147862
Name:BUDKE, MATTHEW BRENDAN (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRENDAN
Last Name:BUDKE
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 1:11039 HUNTWICKE PL
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-6640
Mailing Address - Country:US
Mailing Address - Phone:513-604-2047
Mailing Address - Fax:
Practice Address - Street 1:11039 HUNTWICKE PL
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-6640
Practice Address - Country:US
Practice Address - Phone:513-604-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY016491183500000X
OH03232808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist