Provider Demographics
NPI:1457620635
Name:LASSFOLK, MATTHEW E (RPH, MS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:LASSFOLK
Suffix:
Gender:M
Credentials:RPH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NE HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-3503
Mailing Address - Country:US
Mailing Address - Phone:541-660-4323
Mailing Address - Fax:
Practice Address - Street 1:1690 ALLEN CREEK RD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5559
Practice Address - Country:US
Practice Address - Phone:541-471-9046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-18
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-76391835P0018X
ORRPH-0007639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist