Provider Demographics
NPI:1225381585
Name:MATHARU, SUKHMANI K
Entity Type:Individual
Prefix:DR
First Name:SUKHMANI
Middle Name:K
Last Name:MATHARU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S EUTAW ST APT 1604
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1638
Mailing Address - Country:US
Mailing Address - Phone:301-437-5587
Mailing Address - Fax:
Practice Address - Street 1:19 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-6420
Practice Address - Country:US
Practice Address - Phone:301-437-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20898183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist