Provider Demographics
NPI:1669848115
Name:MATHEW, TITUS THOMAS (PHARMACY INTERN)
Entity Type:Individual
Prefix:DR
First Name:TITUS
Middle Name:THOMAS
Last Name:MATHEW
Suffix:
Gender:F
Credentials:PHARMACY INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 ELM LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2406
Mailing Address - Country:US
Mailing Address - Phone:516-225-6216
Mailing Address - Fax:
Practice Address - Street 1:118 ELM LN
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2406
Practice Address - Country:US
Practice Address - Phone:516-225-6216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician