Provider Demographics
NPI:1477759637
Name:MATTIE, ANN MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:MATTIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:GOVEKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1079 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4303
Mailing Address - Country:US
Mailing Address - Phone:814-539-1833
Mailing Address - Fax:
Practice Address - Street 1:1079 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4303
Practice Address - Country:US
Practice Address - Phone:814-539-1833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027385L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist