Provider Demographics
NPI:1336897594
Name:TART, MATTLYN LAUREN (PHARMD, CPP)
Entity Type:Individual
Prefix:DR
First Name:MATTLYN
Middle Name:LAUREN
Last Name:TART
Suffix:
Gender:F
Credentials:PHARMD, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7505
Mailing Address - Country:US
Mailing Address - Phone:919-784-3100
Mailing Address - Fax:
Practice Address - Street 1:2076 NC HIGHWAY 42 W STE 100
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5303
Practice Address - Country:US
Practice Address - Phone:919-359-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29740183500000X
NC7003531835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist