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General NPI Number Information
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NPI Number | 1578298881
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Entity Type | Individual
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Provider Name | JAMES JOSEPH MATIS JR. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 1111 E END BLVD
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City | WILKES BARRE
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State | PA
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Zip | 18711-0030
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Country | US
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Telephone | 570-824-3521
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Fax |
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Provider Business Mailing Address
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Address Line | 481 PAULETTE AVE
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City | UNIONTOWN
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State | PA
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Zip | 15401-8975
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Country | US
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Telephone | 724-880-9574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | RP456821
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License Number State | PA
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