Provider Demographics
NPI:1770063059
Name:LINDAHL, MATTHEW CARL (RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CARL
Last Name:LINDAHL
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 1:541 EVERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-3205
Mailing Address - Country:US
Mailing Address - Phone:610-216-1848
Mailing Address - Fax:
Practice Address - Street 1:1628 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4922
Practice Address - Country:US
Practice Address - Phone:610-797-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP045632L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist