Provider Demographics
NPI:1063002285
Name:SAWKA, MATTHEW PAUL
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PAUL
Last Name:SAWKA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 SHOEMAKER ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2734
Mailing Address - Country:US
Mailing Address - Phone:570-903-3096
Mailing Address - Fax:
Practice Address - Street 1:347 S BLAKELY ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2254
Practice Address - Country:US
Practice Address - Phone:570-342-9138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR70044183500000X
PARP455106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist