MEDICARE: MR. ROCCO JOSEPH DIMATTIA III RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP040162L	PA

General Provider Information

NPI Number	:	1225036874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROCCO JOSEPH DIMATTIA III RPH

Provider Business Mailing Address
First Line	:	6 SUNSET DR
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-4928
Country	:	US
Telephone Number	:	215-468-1202
Fax Number	:	215-551-0468

Provider Business Practice Location Address
First Line	:	1300 S 18TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-4601
Country	:	US
Telephone Number	:	215-468-1202
Fax Number	:	215-551-4068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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