Healthcare Provider Details

I. General information

NPI: 1295067700
Provider Name (Legal Business Name): MATTHEW HARRICK R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 W 26TH ST
ERIE PA
16508-1302
US

IV. Provider business mailing address

1520 W 26TH ST
ERIE PA
16508-1302
US

V. Phone/Fax

Practice location:
  • Phone: 814-455-9500
  • Fax:
Mailing address:
  • Phone: 814-455-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP043494L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: