Provider Demographics
NPI:1548783616
Name:MATTHEWS, LENA KAITLYN (PHARMD,RPH)
Entity Type:Individual
Prefix:DR
First Name:LENA
Middle Name:KAITLYN
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 CREEK RIDGE LN APT U
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3859
Mailing Address - Country:US
Mailing Address - Phone:304-767-0639
Mailing Address - Fax:
Practice Address - Street 1:1900 CAMERON ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1307
Practice Address - Country:US
Practice Address - Phone:919-833-5523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist