Provider Demographics
NPI:1104037308
Name:MATALIA, MONICA D (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:D
Last Name:MATALIA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 SPRING GARDEN ST
Mailing Address - Street 2:#3F
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-5005
Mailing Address - Country:US
Mailing Address - Phone:215-680-5395
Mailing Address - Fax:215-487-2414
Practice Address - Street 1:5927 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1613
Practice Address - Country:US
Practice Address - Phone:215-487-3419
Practice Address - Fax:215-487-2412
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist