Provider Demographics
NPI:1265772149
Name:MATZA, ROBERT DANIEL JR (PHARMD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DANIEL
Last Name:MATZA
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:D
Other - Last Name:MATZA
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1222 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5466
Mailing Address - Country:US
Mailing Address - Phone:215-941-6240
Mailing Address - Fax:215-941-6244
Practice Address - Street 1:1222 WALNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5466
Practice Address - Country:US
Practice Address - Phone:215-941-6240
Practice Address - Fax:215-941-6244
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441889183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP441889OtherPA STATE LICENSE
PARPI003860OtherPA INJECTABLE LICENSE