Individual
ANNA V MATLASHEVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARM. D
Contact information
Practice address
1400 W CHINDEN BLVD, MERIDIAN, ID 83646-5328
(208) 893-6033
Mailing address
1400 W CHINDEN BLVD, MERIDIAN, ID 83646-5328
(208) 893-6033
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
P7059
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS36009
PHARMACIST CONTROLLED SUBSTANCE REGISTRATION
ID
01
—
P7059
PHARMACIST LICENSE
ID
Enumeration date
07/03/2014
Last updated
07/03/2014
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