Provider Demographics
NPI:1902498330
Name:DECESARE, MATTHEW STEVEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:STEVEN
Last Name:DECESARE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8508 N SHORESIDE WAY NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-6608
Mailing Address - Country:US
Mailing Address - Phone:210-232-6284
Mailing Address - Fax:
Practice Address - Street 1:900 N JK POWELL BLVD
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2115
Practice Address - Country:US
Practice Address - Phone:910-642-0194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30163183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist