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NPI Code Detail

MEDICARE: STACEY MATARESE RPH

MEDICARE: STACEY MATARESE RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist45674TX

General Provider Information

NPI Number : 1255669594
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY MATARESE RPH
Provider Business Mailing Address
First Line : 4703 W COMMERCE ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78237-1502
Country : US
Telephone Number : 210-451-0392
Fax Number : 210-434-7943
Provider Business Practice Location Address
First Line : 4703 W COMMERCE ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78237-1502
Country : US
Telephone Number : 210-434-5566
Fax Number : 210-434-7943
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2009
Last Update Date : 11/24/2009

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