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General NPI Number Information
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NPI Number | 1578851960
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Entity Type | Organization
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Legal Business Name | MATTHEWS FREE MEDICAL CLINIC
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Dates
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Enumeration Date | 07/19/2011
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Last Update Date | 07/19/2011
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Provider Practice Location Address
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Address Line | 113 N AMES ST
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City | MATTHEWS
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State | NC
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Zip | 28105-5639
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Country | US
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Telephone | 704-841-8882
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Fax |
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Provider Business Mailing Address
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Address Line | 113 N AMES ST
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City | MATTHEWS
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State | NC
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Zip | 28105-5639
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Country | US
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Telephone | 704-841-8882
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Fax |
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Authorized Official
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Title or Position | CLINICAL PHARMACIST
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Name | DR. JACQUELINE L OLIN
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Credential | PHARMD
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Telephone | 704-841-8882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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