Provider Demographics
NPI:1265846257
Name:MATTHEWS, DEBRA (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:15428 BASSFORD RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4330
Mailing Address - Country:US
Mailing Address - Phone:240-607-9583
Mailing Address - Fax:301-997-0054
Practice Address - Street 1:26020 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2001
Practice Address - Country:US
Practice Address - Phone:301-475-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14758183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist