Provider Demographics
NPI:1225350622
Name:MATTZELA, BARBARA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:MARIE
Last Name:MATTZELA
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 1:3080 DALSON RD
Mailing Address - Street 2:
Mailing Address - City:TWIN LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49457-9208
Mailing Address - Country:US
Mailing Address - Phone:231-773-9188
Mailing Address - Fax:231-773-1451
Practice Address - Street 1:1501 E APPLE AVE STE C
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3762
Practice Address - Country:US
Practice Address - Phone:231-773-9188
Practice Address - Fax:231-773-1451
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist