Provider Demographics
NPI:1639469935
Name:KUNSELMAN, MATTHEW SCOTT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:KUNSELMAN
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 1:467 SALEM ROAD
Mailing Address - Street 2:
Mailing Address - City:MAYPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16240
Mailing Address - Country:US
Mailing Address - Phone:814-256-3795
Mailing Address - Fax:
Practice Address - Street 1:201 WEST MAHONING STREET
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767
Practice Address - Country:US
Practice Address - Phone:814-938-9161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist