Provider Demographics
NPI:1346762739
Name:MATTSON, LUKE FRANCIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:FRANCIS
Last Name:MATTSON
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 1:60 W HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-1433
Mailing Address - Country:US
Mailing Address - Phone:610-812-7978
Mailing Address - Fax:
Practice Address - Street 1:60 WEST HILLCREST AVENUE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:610-812-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP451483OtherPHARMACY LICENSE
PARPI011407OtherAUTHORIZATION TO ADMINISTER INJECTABLES