Provider Demographics
NPI:1720496490
Name:PHELAN, MATHEW I (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:
Last Name:PHELAN
Suffix:I
Gender:M
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 1:902 ENGH RD
Mailing Address - Street 2:PO BOX 3606
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-9473
Mailing Address - Country:US
Mailing Address - Phone:509-826-6146
Mailing Address - Fax:509-826-6242
Practice Address - Street 1:902 ENGH RD
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841-9473
Practice Address - Country:US
Practice Address - Phone:509-826-6146
Practice Address - Fax:509-826-6242
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00040309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist