Provider Demographics
NPI:1649872557
Name:MATTHEWS, LINVAL A
Entity type:Individual
Prefix:
First Name:LINVAL
Middle Name:A
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 40TH PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20722-1422
Mailing Address - Country:US
Mailing Address - Phone:202-529-7305
Mailing Address - Fax:
Practice Address - Street 1:1535 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5054
Practice Address - Country:US
Practice Address - Phone:202-610-6450
Practice Address - Fax:844-411-6341
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100002328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist