Healthcare Provider Details

I. General information

NPI: 1053926162
Provider Name (Legal Business Name): MATTHEW EDMUND CIPPEL PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 FORD ST
FORD CITY PA
16226-1229
US

IV. Provider business mailing address

PO BOX 151
FORD CITY PA
16226-0151
US

V. Phone/Fax

Practice location:
  • Phone: 724-763-1201
  • Fax:
Mailing address:
  • Phone: 724-763-1201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP454682
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: