Provider Demographics
NPI:1114569134
Name:MATTA, RAMA (RPH)
Entity Type:Individual
Prefix:
First Name:RAMA
Middle Name:
Last Name:MATTA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10143 NE 135TH LN
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2002
Mailing Address - Country:US
Mailing Address - Phone:916-745-2930
Mailing Address - Fax:
Practice Address - Street 1:14729 NE 87TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-6500
Practice Address - Country:US
Practice Address - Phone:916-745-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60946912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist