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General NPI Number Information
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NPI Number | 1700480068
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Entity Type | Individual
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Provider Name | MICHAEL MATULLO
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Gender | Male
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Dates
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Enumeration Date | 11/27/2020
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Last Update Date | 11/27/2020
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Provider Practice Location Address
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Address Line | 1965 ROUTE 57
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City | HACKETTSTOWN
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State | NJ
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Zip | 07840-3475
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Country | US
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Telephone | 908-852-7345
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Fax | 908-813-1043
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Provider Business Mailing Address
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Address Line | 1965 ROUTE 57
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City | HACKETTSTOWN
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State | NJ
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Zip | 07840-3475
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Country | US
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Telephone | 908-852-7345
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Fax | 908-813-1043
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI02616500
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License Number State | NJ
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