Provider Demographics
NPI:1427212869
Name:MATTOS, RITA M (RPH)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:MATTOS
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 1:231 ASHBURTON AVE
Mailing Address - Street 2:JACOBSON PHARMACY
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3227
Mailing Address - Country:US
Mailing Address - Phone:914-965-3049
Mailing Address - Fax:914-965-5246
Practice Address - Street 1:231 ASHBURTON AVE
Practice Address - Street 2:JACOBSON PHARMACY
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3227
Practice Address - Country:US
Practice Address - Phone:914-965-3049
Practice Address - Fax:914-965-5246
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist