Provider Demographics
NPI:1598087397
Name:MATT, MICHELLE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:MATT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514-1206
Mailing Address - Country:US
Mailing Address - Phone:585-594-5689
Mailing Address - Fax:585-594-5712
Practice Address - Street 1:4366 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1206
Practice Address - Country:US
Practice Address - Phone:585-594-5689
Practice Address - Fax:585-594-5712
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI053783-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist