Provider Demographics
NPI:1326360728
Name:MATHEW, SHOLLY MARY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SHOLLY
Middle Name:MARY
Last Name:MATHEW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WHISPERING CT
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1625
Mailing Address - Country:US
Mailing Address - Phone:845-215-9163
Mailing Address - Fax:
Practice Address - Street 1:5 INDIAN ROCK RT 59
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901-1625
Practice Address - Country:US
Practice Address - Phone:845-357-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047018-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist