Provider Demographics
NPI:1588945984
Name:MATTHEWS, JODY ANNE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:ANNE
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 SUMMER ST
Mailing Address - Street 2:APT 18
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2561
Mailing Address - Country:US
Mailing Address - Phone:339-234-0889
Mailing Address - Fax:
Practice Address - Street 1:135 BROADWAY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1013
Practice Address - Country:US
Practice Address - Phone:978-725-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH275561835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy