1033251830 NPI number — MRS. MARTHA ANETRA MATTHEWS-SHAW PHARM.D

Table of content: MRS. MARTHA ANETRA MATTHEWS-SHAW PHARM.D (NPI 1033251830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033251830 NPI number — MRS. MARTHA ANETRA MATTHEWS-SHAW PHARM.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS-SHAW
Provider First Name:
MARTHA
Provider Middle Name:
ANETRA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATTHEWS
Provider Other First Name:
MARTHA
Provider Other Middle Name:
ANETRA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033251830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 40932
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38174-0932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-579-9039
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5197 BRUNSWICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRUNSWICK
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-388-0507
Provider Business Practice Location Address Fax Number:
901-388-0407
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  12355 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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