Provider Demographics
NPI:1821422569
Name:MATTHEWS HEALTH MART
Entity Type:Organization
Organization Name:MATTHEWS HEALTH MART
Other - Org Name:MATTHEWS DRUG STORE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-592-3121
Mailing Address - Street 1:408 NORTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2434
Mailing Address - Country:US
Mailing Address - Phone:910-592-3121
Mailing Address - Fax:910-592-3144
Practice Address - Street 1:408 NORTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2434
Practice Address - Country:US
Practice Address - Phone:910-592-3121
Practice Address - Fax:910-592-3144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC02621333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy