MEDICARE: DR. MICHELE L MATTHEWS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	25953	MA
2	1835P1200X	Pharmacotherapy Pharmacist	25953	MA
3	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	25953	MA

General Provider Information

NPI Number	:	1063409183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELE L MATTHEWS PHARMD

Provider Business Mailing Address
First Line	:	179 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5804
Country	:	US
Telephone Number	:	617-879-5967
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 BOYLSTON ST
Second Line	:
City	:	CHESTNUT HILL
State	:	MA
Zip	:	02467-2477
Country	:	US
Telephone Number	:	617-732-9060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/06/2010

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