Provider Demographics
NPI:1487855573
Name:MATTHEWS, ROBERTA DUNCAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:DUNCAN
Last Name:MATTHEWS
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 1:91 BEAR GULCH RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-9600
Mailing Address - Country:US
Mailing Address - Phone:360-532-8992
Mailing Address - Fax:
Practice Address - Street 1:310 MYRTLE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-4416
Practice Address - Country:US
Practice Address - Phone:360-533-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist