Provider Demographics
NPI:1376826750
Name:MATHEW, ANU KOSHY
Entity Type:Individual
Prefix:DR
First Name:ANU
Middle Name:KOSHY
Last Name:MATHEW
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 1:2966 EVERSON RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4405
Mailing Address - Country:US
Mailing Address - Phone:954-873-1823
Mailing Address - Fax:
Practice Address - Street 1:2966 EVERSON RIDGE CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4405
Practice Address - Country:US
Practice Address - Phone:954-873-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGARPH024410183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist