Provider Demographics
NPI:1699042218
Name:MATTHIS, CARMEN NEGRETE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:NEGRETE
Last Name:MATTHIS
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 1:1460 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8525
Mailing Address - Country:US
Mailing Address - Phone:541-673-1465
Mailing Address - Fax:
Practice Address - Street 1:3013 NW STEWART PKWY
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1612
Practice Address - Country:US
Practice Address - Phone:541-957-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010411183500000X
CA29766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist