Individual ProviderJeremy Kang MatsumotoPharmacistPharmacy Service ProvidersPractice Address60 Mdg/Sgqp 101 Bodin Cir, Bldg. 777, Travis Afb, CA 94535-4028(707) 423-7656(707) 423-7194PECOS EnrollmentBased on the most recent information from CMS, provider Jeremy Kang Matsumoto does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:10 AM.Profile DetailsProvider ID1568936300Provider TypeIndividualFull NameMatsumoto, Jeremy KangCredentialPHARMDGenderMaleSole ProprietorNoEnumeration Date1/15/2019Last Updated11/12/2021Contact InformationPractice LocationPractice Address60 Mdg/Sgqp 101 Bodin Cir, Bldg. 777, Travis Afb, CA 94535-4028Phone(707) 423-7656FaxUnlisted FaxMailing LocationMailing Address101 Bodin Circle, Building 777, Travis Afb, CA 94535Phone(707) 423-7194FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode183500000XPrimaryDescriptionPharmacistPharmacy Service ProvidersLicenseS023271ArizonaCode183500000XDescriptionPharmacistPharmacy Service ProvidersLicense79163California