MEDICARE: MR. ROBERT DANIEL MATZA JR. PHARMD

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
1	183500000X	Pharmacist	RP441889	PA

General Provider Information

NPI Number	:	1265772149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT DANIEL MATZA JR. PHARMD

Provider Business Mailing Address
First Line	:	1222 WALNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5466
Country	:	US
Telephone Number	:	215-941-6240
Fax Number	:	215-941-6244

Provider Business Practice Location Address
First Line	:	1222 WALNUT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5466
Country	:	US
Telephone Number	:	215-941-6240
Fax Number	:	215-941-6244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2013
Last Update Date	:	04/03/2021

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