Provider Demographics
NPI:1821514894
Name:MATTIN, EMILY DEVOE (RPH)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:DEVOE
Last Name:MATTIN
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 1:1600 N COLFAX ST APT 8
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-4755
Mailing Address - Country:US
Mailing Address - Phone:401-935-7102
Mailing Address - Fax:
Practice Address - Street 1:9055 SW MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7434
Practice Address - Country:US
Practice Address - Phone:503-207-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0016130183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist