Provider Demographics
NPI:1932472164
Name:MATSON, CATHLEEN (RPH)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
Last Name:MATSON
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 1:3936 92ND DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2100
Mailing Address - Country:US
Mailing Address - Phone:515-314-5160
Mailing Address - Fax:
Practice Address - Street 1:3936 92ND DR
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2100
Practice Address - Country:US
Practice Address - Phone:515-314-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2012-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA16070183500000X
WI10624183500000X
FLPS 33823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist