Provider Demographics
NPI:1740329465
Name:MATLIS, RITA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:MATLIS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GERALD RD
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945
Mailing Address - Country:US
Mailing Address - Phone:781-639-1722
Mailing Address - Fax:
Practice Address - Street 1:1 VILLAGE PLZ
Practice Address - Street 2:OFF PLEASANT ST
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2373
Practice Address - Country:US
Practice Address - Phone:781-631-8100
Practice Address - Fax:781-639-2919
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist