Provider Demographics
NPI:1134443146
Name:MATHEWS, JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2135
Mailing Address - Country:US
Mailing Address - Phone:231-861-6945
Mailing Address - Fax:231-861-6938
Practice Address - Street 1:3001 W M 20
Practice Address - Street 2:
Practice Address - City:NEW ERA
Practice Address - State:MI
Practice Address - Zip Code:49446-8173
Practice Address - Country:US
Practice Address - Phone:231-861-6945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI532020859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302020859OtherPHARMACY LICENSE