Healthcare Provider Details

I. General information

NPI: 1154608420
Provider Name (Legal Business Name): MATTHEW PAUL WYSE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 SALTSBURG RD
PITTSBURGH PA
15235-2067
US

IV. Provider business mailing address

6201 SALTSBURG RD
PITTSBURGH PA
15235-2067
US

V. Phone/Fax

Practice location:
  • Phone: 412-793-7328
  • Fax:
Mailing address:
  • Phone: 412-793-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP440875
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: