Individual
RANDOLPH MATTILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1208 BONITA ST, GRANTS, NM 87020-2234
(505) 287-2600
Mailing address
36 HAMILTON RD, GRANTS, NM 87020-3766
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RP00004614
NM
Other
Enumeration date
08/23/2014
Last updated
08/23/2014
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