Provider Demographics
NPI:1487977575
Name:GRASSI, MATTHEW P (RPH)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:P
Last Name:GRASSI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-9759
Mailing Address - Country:US
Mailing Address - Phone:518-542-2351
Mailing Address - Fax:
Practice Address - Street 1:320 WEST BRIDGE ST
Practice Address - Street 2:PRICE CHOPPER PHARMACY 042
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414
Practice Address - Country:US
Practice Address - Phone:518-943-3909
Practice Address - Fax:518-943-9280
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist