Charles Elias Matli, PHARMD
Individual provider Active NPI Pharmacist · Crownpoint, NM
NPI 1770041758 · NPPES record last updated Feb 23, 2022
Key facts
- NPI
- 1770041758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P8174 (ID)
- Practice address
- Junction of Hwy 371 and Navajo Service Route 9
Crownpoint, NM 87313 - Phone
- (505) 786-6344
- Fax
- (505) 786-2526
- NPI assigned
- Mar 8, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P8174 | ID | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P8174 | ID | Yes |
Addresses
Primary practice location
Junction of Hwy 371 and Navajo Service Route 9
Crownpoint, NM 87313
Mailing address
3134 Summer Dr
Lakeside, AZ 85929-6726
Phone (917) 748-5678
Other providers in Crownpoint, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.