Provider Demographics
NPI:1750664868
Name:VITALE, MATTHEW M (RPH)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:M
Last Name:VITALE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-2029
Mailing Address - Country:US
Mailing Address - Phone:401-231-6561
Mailing Address - Fax:401-232-7285
Practice Address - Street 1:25 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-2029
Practice Address - Country:US
Practice Address - Phone:401-231-6561
Practice Address - Fax:401-232-7285
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist