Healthcare Provider Details

I. General information

NPI: 1033251830
Provider Name (Legal Business Name): MARTHA ANETRA MATTHEWS-SHAW PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA ANETRA MATTHEWS PHARM.D

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5197 BRUNSWICK RD
BRUNSWICK TN
38014
US

IV. Provider business mailing address

PO BOX 40932
MEMPHIS TN
38174-0932
US

V. Phone/Fax

Practice location:
  • Phone: 877-388-0507
  • Fax: 901-388-0407
Mailing address:
  • Phone: 901-579-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12355
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: