Provider Demographics
NPI:1861819427
Name:MATHEWS, MICHELE ANNE (RPH)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANNE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 CRESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-9527
Mailing Address - Country:US
Mailing Address - Phone:330-699-4184
Mailing Address - Fax:
Practice Address - Street 1:472 CRESTHILL DR
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-9527
Practice Address - Country:US
Practice Address - Phone:330-699-4184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03314484183500000X
NC06477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist