Provider Demographics
NPI:1629305735
Name:MATHEW, VIJI (RPH)
Entity Type:Individual
Prefix:
First Name:VIJI
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4515
Mailing Address - Country:US
Mailing Address - Phone:919-751-5548
Mailing Address - Fax:919-751-8194
Practice Address - Street 1:2606 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4515
Practice Address - Country:US
Practice Address - Phone:919-751-5548
Practice Address - Fax:919-751-8194
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist