Provider Demographics
NPI:1598087314
Name:MATHEW, ANNIE PHILIP
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:PHILIP
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 1:1525 SADLER RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4467
Mailing Address - Country:US
Mailing Address - Phone:904-261-2663
Mailing Address - Fax:904-261-3796
Practice Address - Street 1:1525 SADLER RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4467
Practice Address - Country:US
Practice Address - Phone:904-261-2663
Practice Address - Fax:904-261-3796
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist