Provider Demographics
NPI:1619258290
Name:MATHEW, SAJU T (RPH)
Entity Type:Individual
Prefix:
First Name:SAJU
Middle Name:T
Last Name:MATHEW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 AUBURN SHORES DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4705
Mailing Address - Country:US
Mailing Address - Phone:713-436-2961
Mailing Address - Fax:
Practice Address - Street 1:7929 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1701
Practice Address - Country:US
Practice Address - Phone:713-383-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist