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Individual

MRS. ALICIA SHANA MATTSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
R.PH.

Contact information

Practice address
335 E JIMMIE LEEDS RD, GALLOWAY, NJ 08205-4127
(609) 748-2449
(609) 748-0959
Mailing address
335 E JIMMIE LEEDS RD, GALLOWAY, NJ 08205-4127
(609) 748-2449
(609) 748-0959

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI02596800
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
28RI02596800
STATE LICENSE NUMBER
NJ
01
28RJ02336
STATE IMMUNIZATION PROVIDER NUMBER
NJ
Enumeration date
10/04/2010
Last updated
10/04/2010
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