Matthew Renzi
Individual provider Active NPI Pharmacist · Old Forge, PA
NPI 1861089799 · NPPES record last updated Dec 27, 2020
Key facts
- NPI
- 1861089799
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RP445827 (PA)
- Practice address
- 101 S Main St
Old Forge, PA 18518-1602 - Phone
- (570) 457-2182
- Fax
- (570) 457-4684
- NPI assigned
- Dec 27, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| RP445827 | PA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RP445827 | PA | Yes |
Addresses
Primary practice location
101 S Main St
Old Forge, PA 18518-1602
Mailing address
101 S Main St
Old Forge, PA 18518-1602
Phone (570) 457-2182
Other providers in Old Forge, 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.