Provider Demographics
NPI:1538909106
Name:MATT'S COASTAL PHARMACY LLC
Entity type:Organization
Organization Name:MATT'S COASTAL PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JENNINGS
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:401-575-6635
Mailing Address - Street 1:88 E MAIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-4912
Mailing Address - Country:US
Mailing Address - Phone:401-619-5020
Mailing Address - Fax:401-619-4249
Practice Address - Street 1:88 E MAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-4912
Practice Address - Country:US
Practice Address - Phone:401-619-5020
Practice Address - Fax:401-619-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy