Provider Demographics
NPI:1386059327
Name:MONTVILLE, MATTHEW (PHARM D)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:MONTVILLE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BRIAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-8009
Mailing Address - Country:US
Mailing Address - Phone:570-417-2773
Mailing Address - Fax:
Practice Address - Street 1:20 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1213
Practice Address - Country:US
Practice Address - Phone:570-824-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-29
Last Update Date:2014-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP448707183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP448707OtherPENNSYLVANIA PHARMACY LICENSE