Provider Demographics
NPI:1851441232
Name:MATALIA, BAKUL N (RPH)
Entity Type:Individual
Prefix:
First Name:BAKUL
Middle Name:N
Last Name:MATALIA
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 1:15 TWIN CT
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1546
Mailing Address - Country:US
Mailing Address - Phone:631-567-7177
Mailing Address - Fax:631-581-9410
Practice Address - Street 1:126 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2600
Practice Address - Country:US
Practice Address - Phone:631-581-9620
Practice Address - Fax:631-581-9410
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031828183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist