Healthcare Provider Details

I. General information

NPI: 1447300462
Provider Name (Legal Business Name): MATTHEW VACCARI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E DOVER ST HILL'S DRUG STORE
EASTON MD
21601-3048
US

IV. Provider business mailing address

30 E DOVER ST HILL'S DRUG STORE
EASTON MD
21601-3048
US

V. Phone/Fax

Practice location:
  • Phone: 410-822-1234
  • Fax: 410-820-9057
Mailing address:
  • Phone: 410-822-1234
  • Fax: 410-820-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16372
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: