Provider Demographics
NPI:1720415243
Name:MATTHEWS, KIA LYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KIA
Middle Name:LYNN
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 1:1108 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3301
Mailing Address - Country:US
Mailing Address - Phone:843-460-8453
Mailing Address - Fax:
Practice Address - Street 1:1108 MEADOW DR
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3301
Practice Address - Country:US
Practice Address - Phone:843-460-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-29
Last Update Date:2013-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP447610183500000X
SC12427183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist