Provider Demographics
NPI:1356474308
Name:MATHARU, MANJIT SINGH
Entity Type:Individual
Prefix:MR
First Name:MANJIT
Middle Name:SINGH
Last Name:MATHARU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 S COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-6577
Mailing Address - Country:US
Mailing Address - Phone:813-752-1133
Mailing Address - Fax:813-752-8866
Practice Address - Street 1:1423 S COLLINS ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-6577
Practice Address - Country:US
Practice Address - Phone:813-752-1133
Practice Address - Fax:813-752-8866
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32197OtherFL PHARMACY LICENSE NUMBE