MEDICARE: DR. MATTHEW M RAFA PHARM.D.

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	RP0007530	WV

General Provider Information

NPI Number	:	1881909364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW M RAFA PHARM.D.

Provider Business Mailing Address
First Line	:	200 MOUNT DE CHANTAL RD
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-6563
Country	:	US
Telephone Number	:	304-233-5485
Fax Number	:	304-233-5488

Provider Business Practice Location Address
First Line	:	200 MOUNT DE CHANTAL RD
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-6563
Country	:	US
Telephone Number	:	304-233-5485
Fax Number	:	304-233-5488

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	08/09/2010

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