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General NPI Number Information
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NPI Number | 1821514894
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Entity Type | Individual
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Provider Name | EMILY DEVOE MATTIN RPH
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 9055 SW MURRAY BLVD
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City | BEAVERTON
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State | OR
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Zip | 97008-7434
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Country | US
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Telephone | 503-207-9915
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 N COLFAX ST APT 8
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City | PORTLAND
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State | OR
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Zip | 97217-4755
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Country | US
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Telephone | 401-935-7102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 0016130
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License Number State | OR
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