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NPI Code Detail

MEDICARE: MATTHEW B SHAVER JR.

MEDICARE: MATTHEW B SHAVER JR.
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
1183500000XPharmacistRP456726PA

General Provider Information

NPI Number : 1639774532
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW B SHAVER JR.
Provider Business Mailing Address
First Line : 5 CHURCH ST
Second Line :
City : DALLAS
State : PA
Zip : 18612-1155
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5 CHURCH ST
Second Line :
City : DALLAS
State : PA
Zip : 18612-1155
Country : US
Telephone Number : 570-675-1076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2020
Last Update Date : 12/01/2020

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Directions to “ MATTHEW B SHAVER JR. ” Practice Location

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