Provider Demographics
NPI:1174815344
Name:MATTOES, HOLLY MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:MARIE
Last Name:MATTOES
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 1:1200 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1820
Mailing Address - Country:US
Mailing Address - Phone:401-272-3048
Mailing Address - Fax:401-621-1888
Practice Address - Street 1:1200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1820
Practice Address - Country:US
Practice Address - Phone:401-272-3048
Practice Address - Fax:401-621-1888
Is Sole Proprietor?:No
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH04101183500000X
FLPS45992183500000X
MAPH232472183500000X
CTPCT0009149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist