=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609181379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. MATTHEW N LAMELZA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2010
-----------------------------------------------------
Last Update Date | 08/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RITE AID #116 907 N HIGH ST
-----------------------------------------------------
City | MILLVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-825-7742
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 ATLANTIC AVE UNIT C
-----------------------------------------------------
City | OCEAN CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08226-4361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-398-1368
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI02449200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------