Provider Demographics
NPI:1750670444
Name:MATKOWSKI, JAMINE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JAMINE
Middle Name:M
Last Name:MATKOWSKI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:MATKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:6351 W RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7634
Mailing Address - Country:US
Mailing Address - Phone:509-579-4791
Mailing Address - Fax:509-579-5907
Practice Address - Street 1:6351 W RIO GRANDE AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7634
Practice Address - Country:US
Practice Address - Phone:509-579-4791
Practice Address - Fax:509-579-5907
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0009610183500000X
IDP5404183500000X
WA00016305183500000X
WAPH00016305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist