Provider Demographics
NPI:1750026647
Name:MINUTOLO, MATTHEW G (RPH)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:G
Last Name:MINUTOLO
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 1:69 1/2 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-1913
Mailing Address - Country:US
Mailing Address - Phone:203-822-2812
Mailing Address - Fax:
Practice Address - Street 1:1203 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1214
Practice Address - Country:US
Practice Address - Phone:203-322-7669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist