Provider Demographics
NPI:1942697289
Name:FEBBO, MATTHEW (RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FEBBO
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 1:150 S INDEPENDENCE MALL W
Mailing Address - Street 2:SUITE 216
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3413
Mailing Address - Country:US
Mailing Address - Phone:215-861-4196
Mailing Address - Fax:
Practice Address - Street 1:150 S INDEPENDENCE MALL W
Practice Address - Street 2:SUITE 216
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3413
Practice Address - Country:US
Practice Address - Phone:215-861-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-043247L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist