Healthcare Provider Details

I. General information

NPI: 1205562105
Provider Name (Legal Business Name): MATTHEW JAMES CAVALETTO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 ATLANTIC AVE STE 200
RALEIGH NC
27604-1502
US

IV. Provider business mailing address

7 TAVERN PL
DURHAM NC
27707-9758
US

V. Phone/Fax

Practice location:
  • Phone: 919-755-2620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberP9548
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: