Provider Demographics
NPI:1720462898
Name:JANUSKI, MATTHEW (RPH)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:JANUSKI
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 1:8 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1706
Mailing Address - Country:US
Mailing Address - Phone:570-283-9251
Mailing Address - Fax:
Practice Address - Street 1:910 WILKES BARRE TOWNSHIP BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6162
Practice Address - Country:US
Practice Address - Phone:570-823-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449668183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist