Provider Demographics
NPI:1558875831
Name:COLELLA, PAUL MATTHEW JR (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MATTHEW
Last Name:COLELLA
Suffix:JR
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ASHBY CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-3330
Mailing Address - Country:US
Mailing Address - Phone:609-651-0215
Mailing Address - Fax:
Practice Address - Street 1:820 COOPER ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2598
Practice Address - Country:US
Practice Address - Phone:856-686-1382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03911500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist