Provider Demographics
NPI:1164755997
Name:MATASSA, AMANDA BREMNER (PHARMD, CSP)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:BREMNER
Last Name:MATASSA
Suffix:
Gender:F
Credentials:PHARMD, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 FOREST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1730
Mailing Address - Country:US
Mailing Address - Phone:804-893-8630
Mailing Address - Fax:
Practice Address - Street 1:6900 FOREST AVE STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1730
Practice Address - Country:US
Practice Address - Phone:804-893-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist