Provider Demographics
NPI:1629150693
Name:MATTSON, JARED MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:MATTSON
Suffix:
Gender:M
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:PO BOX 1081
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-1081
Mailing Address - Country:US
Mailing Address - Phone:907-687-0303
Mailing Address - Fax:828-236-0786
Practice Address - Street 1:1124 PATTON AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2706
Practice Address - Country:US
Practice Address - Phone:828-236-9848
Practice Address - Fax:828-236-0786
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1689183500000X
NC21306183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist