Provider Demographics
NPI:1184805814
Name:MESI, MATTHEW MICHAEL (RPH)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:MICHAEL
Last Name:MESI
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 1:2401 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2805
Mailing Address - Country:US
Mailing Address - Phone:716-895-8271
Mailing Address - Fax:716-893-9981
Practice Address - Street 1:2401 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2805
Practice Address - Country:US
Practice Address - Phone:716-895-8271
Practice Address - Fax:716-893-9981
Is Sole Proprietor?:No
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00846828Medicaid