Provider Demographics
NPI:1477030674
Name:MATTHEW 725 INC
Entity Type:Organization
Organization Name:MATTHEW 725 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:MOUGEOT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:904-860-4948
Mailing Address - Street 1:2683 SAINT JOHNS BLUFF RD S STE 135
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-3765
Mailing Address - Country:US
Mailing Address - Phone:904-513-4075
Mailing Address - Fax:
Practice Address - Street 1:2683 SAINT JOHNS BLUFF RD S STE 135
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-3765
Practice Address - Country:US
Practice Address - Phone:904-513-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH314623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy