Matthew Robert Baccarella
Individual provider Active NPI Pharmacist · Wind Gap, PA
NPI 1760079693 · NPPES record last updated Dec 27, 2020
Key facts
- NPI
- 1760079693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP450660 (PA)
- Practice address
- 855 S Broadway
Wind Gap, PA 18091-1629 - Phone
- (610) 863-5341
- NPI assigned
- Dec 27, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RP450660 | PA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pennsylvania CVS Pharmacy LLC | Past |
Accepting new patients | |
| Pennsylvania CVS Pharmacy, L.L.C. | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP450660 | PA | Yes |
Addresses
Primary practice location
855 S Broadway
Wind Gap, PA 18091-1629
Mailing address
855 S Broadway
Wind Gap, PA 18091-1629
Phone (610) 863-5341
Other providers in Wind Gap, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.