Provider Demographics
NPI:1407462781
Name:MATARA, ESTHER NJERI
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:NJERI
Last Name:MATARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4457 HIGH GATE DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8871
Mailing Address - Country:US
Mailing Address - Phone:678-697-3305
Mailing Address - Fax:
Practice Address - Street 1:2701 FAIRBURN RD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2941
Practice Address - Country:US
Practice Address - Phone:770-489-2734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH-032339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist