Provider Demographics
NPI:1679178081
Name:DIMATTIO, ANTHONY SCOTT (RPH)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SCOTT
Last Name:DIMATTIO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 BAYBERRY ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3132
Mailing Address - Country:US
Mailing Address - Phone:330-284-6170
Mailing Address - Fax:
Practice Address - Street 1:500 S WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3548
Practice Address - Country:US
Practice Address - Phone:330-678-4009
Practice Address - Fax:330-678-1576
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-123271835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist