Provider Demographics
NPI:1265743124
Name:MATA, AMY (PHARM D)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:MATA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7466 OAK RIDGE HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3480
Mailing Address - Country:US
Mailing Address - Phone:865-769-8326
Mailing Address - Fax:865-769-8656
Practice Address - Street 1:7466 OAK RIDGE HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-3480
Practice Address - Country:US
Practice Address - Phone:865-769-8326
Practice Address - Fax:865-769-8656
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22279183500000X
WVRP0006664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist