Provider Demographics
NPI:1699245563
Name:DUNN-MAHAR, MATTEA BREEZE (PHARMD)
Entity type:Individual
Prefix:
First Name:MATTEA
Middle Name:BREEZE
Last Name:DUNN-MAHAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:DUNN-MAHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7155 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7155 E STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367
Practice Address - Country:US
Practice Address - Phone:315-376-7030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058225183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist