Provider Demographics
NPI:1902064355
Name:MATTSON, REBECCA LYNN (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNN
Last Name:MATTSON
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 MOSA DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6834
Mailing Address - Country:US
Mailing Address - Phone:907-687-0271
Mailing Address - Fax:
Practice Address - Street 1:664 CHEROKEE CROSSING
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:NC
Practice Address - Zip Code:28789
Practice Address - Country:US
Practice Address - Phone:828-497-2273
Practice Address - Fax:828-497-2873
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-31
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist