Provider Demographics
NPI:1033251830
Name:MATTHEWS-SHAW, MARTHA ANETRA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ANETRA
Last Name:MATTHEWS-SHAW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:ANETRA
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 40932
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-0932
Mailing Address - Country:US
Mailing Address - Phone:901-579-9039
Mailing Address - Fax:
Practice Address - Street 1:5197 BRUNSWICK RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:TN
Practice Address - Zip Code:38014
Practice Address - Country:US
Practice Address - Phone:877-388-0507
Practice Address - Fax:901-388-0407
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12355183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist