Provider Demographics
NPI:1104950328
Name:DEMATTO, PATRICIA ANN (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:DEMATTO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W MOUNTAIN TOP RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18250-1758
Mailing Address - Country:US
Mailing Address - Phone:570-645-6391
Mailing Address - Fax:
Practice Address - Street 1:200 SOUTH BEST AVE
Practice Address - Street 2:
Practice Address - City:WALNUTPORT
Practice Address - State:PA
Practice Address - Zip Code:18088
Practice Address - Country:US
Practice Address - Phone:610-767-9595
Practice Address - Fax:610-760-2531
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044024L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP044024LOtherPHARMACIST LICENSE