Provider Demographics
NPI:1003198540
Name:BARTOLO, MATTHEW A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:A
Last Name:BARTOLO
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 1:112 GEORGE RUSSELL WAY
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2682
Mailing Address - Country:US
Mailing Address - Phone:727-631-6050
Mailing Address - Fax:
Practice Address - Street 1:20 ARNOT ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1614
Practice Address - Country:US
Practice Address - Phone:973-470-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445243183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist