Provider Demographics
NPI:1427215318
Name:KEBLER, MATTHEW R (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:KEBLER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:KEBLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:2102 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-3960
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2102 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3960
Practice Address - Country:US
Practice Address - Phone:215-964-9906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP438767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist