Provider Demographics
NPI:1194023598
Name:BOROTA, MATTHEW P (PHARM D)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:P
Last Name:BOROTA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11316 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-2895
Mailing Address - Country:US
Mailing Address - Phone:336-434-9877
Mailing Address - Fax:336-434-9866
Practice Address - Street 1:11316 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2895
Practice Address - Country:US
Practice Address - Phone:336-434-9877
Practice Address - Fax:336-434-9866
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist