Provider Demographics
NPI:1306333141
Name:LYLE, MATTHEW PHILLIP (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PHILLIP
Last Name:LYLE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 LEFEVRE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19137-2044
Mailing Address - Country:US
Mailing Address - Phone:215-535-4111
Mailing Address - Fax:215-535-4115
Practice Address - Street 1:2660 LEFEVRE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-2044
Practice Address - Country:US
Practice Address - Phone:215-535-4111
Practice Address - Fax:215-535-4115
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist