Provider Demographics
NPI:1609427244
Name:MATTA, SAADA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SAADA
Middle Name:
Last Name:MATTA
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 1:34644 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5233
Mailing Address - Country:US
Mailing Address - Phone:586-698-0336
Mailing Address - Fax:586-698-0344
Practice Address - Street 1:34644 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5233
Practice Address - Country:US
Practice Address - Phone:586-698-0336
Practice Address - Fax:586-698-0344
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302029505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist