Provider Demographics
NPI:1083441497
Name:DEMATTHEIS, KAREN (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:DEMATTHEIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 WESTVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5905
Mailing Address - Country:US
Mailing Address - Phone:973-896-0179
Mailing Address - Fax:
Practice Address - Street 1:349 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-4004
Practice Address - Country:US
Practice Address - Phone:973-667-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01884400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist