Healthcare Provider Details

I. General information

NPI: 1013812221
Provider Name (Legal Business Name): KELLY L. MATSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 GREENHOUSE RD
KINGSTON RI
02881-2018
US

IV. Provider business mailing address

7 GREENHOUSE RD
KINGSTON RI
02881-2018
US

V. Phone/Fax

Practice location:
  • Phone: 401-874-5811
  • Fax:
Mailing address:
  • Phone: 401-874-5811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberPS35849
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberPH27412
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1835P0200X
TaxonomyPediatric Pharmacist
License NumberRPH04357
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: