Provider Demographics
NPI:1508188806
Name:MATHEW, PREETHY (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PREETHY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 N ROUTE 303 UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-1768
Mailing Address - Country:US
Mailing Address - Phone:845-510-4198
Mailing Address - Fax:
Practice Address - Street 1:75 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2659
Practice Address - Country:US
Practice Address - Phone:845-735-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051623183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist