Provider Demographics
NPI:1225036874
Name:DIMATTIA, ROCCO JOSEPH III (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROCCO
Middle Name:JOSEPH
Last Name:DIMATTIA
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4928
Mailing Address - Country:US
Mailing Address - Phone:215-468-1202
Mailing Address - Fax:215-551-0468
Practice Address - Street 1:1300 S 18TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4601
Practice Address - Country:US
Practice Address - Phone:215-468-1202
Practice Address - Fax:215-551-4068
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP040162L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist