Provider Demographics
NPI:1215377155
Name:MATHEWS PHARMACY INC
Entity Type:Organization
Organization Name:MATHEWS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:248-817-2882
Mailing Address - Street 1:116 S. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAWSON
Mailing Address - State:MI
Mailing Address - Zip Code:48017-1603
Mailing Address - Country:US
Mailing Address - Phone:248-268-2511
Mailing Address - Fax:248-556-5982
Practice Address - Street 1:116 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017-1603
Practice Address - Country:US
Practice Address - Phone:248-268-2511
Practice Address - Fax:248-556-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy