Provider Demographics
NPI:1962091355
Name:MATHEWS, PATRICIA MARIE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELENA ST APT 221
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4382
Mailing Address - Country:US
Mailing Address - Phone:906-201-0233
Mailing Address - Fax:
Practice Address - Street 1:681 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-3220
Practice Address - Country:US
Practice Address - Phone:401-943-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5351010276183500000X
RIRPH06473183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist