Individual
STEPHANIE MATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
100 E IDAHO ST, BOISE, ID 83712-6267
(812) 223-7853
Mailing address
100 E IDAHO ST, BOISE, ID 83712-6267
(812) 223-7853
Taxonomy
Speciality
Code
Description
License number
State
1835X0200X
Oncology Pharmacist
Primary
P7853
ID
Other
Enumeration date
12/16/2019
Last updated
12/16/2019
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