Provider Demographics
NPI:1699058271
Name:MATULEVICIUS, MARY BETH (RPH)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:MATULEVICIUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 W TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4114
Mailing Address - Country:US
Mailing Address - Phone:610-435-3605
Mailing Address - Fax:610-435-6912
Practice Address - Street 1:1702 W TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4114
Practice Address - Country:US
Practice Address - Phone:610-435-3605
Practice Address - Fax:610-435-6912
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041735L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist