Healthcare Provider Details

I. General information

NPI: 1447234448
Provider Name (Legal Business Name): JENNIFER MICHELE MATIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6619 132ND AVE NE
KIRKLAND WA
98033-8627
US

IV. Provider business mailing address

18214 32ND AVE SE
BOTHELL WA
98012-9347
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-5544
  • Fax: 425-869-2227
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00047728
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13537
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: