Provider Demographics
NPI:1508925470
Name:JOSEPH DI MATTEO INC
Entity Type:Organization
Organization Name:JOSEPH DI MATTEO INC
Other - Org Name:THE MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:412-826-9500
Mailing Address - Street 1:215 ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-2058
Mailing Address - Country:US
Mailing Address - Phone:412-826-9500
Mailing Address - Fax:412-826-1884
Practice Address - Street 1:215 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-2058
Practice Address - Country:US
Practice Address - Phone:412-826-9500
Practice Address - Fax:412-826-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413730L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001021810Medicaid
PA0005599360004Medicaid
PA001021810Medicaid