Provider Demographics
NPI:1346018546
Name:MATTI, LENA (RPH)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:MATTI
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 1:16690 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2043
Mailing Address - Country:US
Mailing Address - Phone:248-835-7023
Mailing Address - Fax:
Practice Address - Street 1:4514 GRATIOT RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-4508
Practice Address - Country:US
Practice Address - Phone:810-364-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302415675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist