Provider Demographics
NPI:1770680027
Name:KLINE, MATTHEW R (RPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:KLINE
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 1:54 E SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-3616
Mailing Address - Country:US
Mailing Address - Phone:856-461-0953
Mailing Address - Fax:
Practice Address - Street 1:54 E SCOTT ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08075-3616
Practice Address - Country:US
Practice Address - Phone:856-461-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02617400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist