Provider Demographics
NPI:1114688488
Name:DIMATTEO, DANTE JESSE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:JESSE
Last Name:DIMATTEO
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 1:215 ALLEGHENY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-2092
Mailing Address - Country:US
Mailing Address - Phone:412-826-9500
Mailing Address - Fax:412-826-1884
Practice Address - Street 1:215 ALLEGHENY AVE STE 102
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-2092
Practice Address - Country:US
Practice Address - Phone:412-826-9500
Practice Address - Fax:412-826-1884
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARPI012508OtherAUTHORIZATION TO ADMINISTER INJECTABLES
PARP452762OtherPHARMACIST LICENSE NUMBER