Provider Demographics
NPI:1114254026
Name:MATHAI, JAIMOL J (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAIMOL
Middle Name:J
Last Name:MATHAI
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 PORTOFINO CT
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6987
Mailing Address - Country:US
Mailing Address - Phone:713-723-4774
Mailing Address - Fax:713-721-1360
Practice Address - Street 1:10800 S POST OAK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-3102
Practice Address - Country:US
Practice Address - Phone:713-723-4774
Practice Address - Fax:713-721-1360
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist