Provider Demographics
NPI:1710439682
Name:MATHEW, ANITHA
Entity Type:Individual
Prefix:
First Name:ANITHA
Middle Name:
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 1:215 WILLIAMSBORO ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-3330
Mailing Address - Country:US
Mailing Address - Phone:919-693-8801
Mailing Address - Fax:919-693-2401
Practice Address - Street 1:215 WILLIAMSBORO ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3330
Practice Address - Country:US
Practice Address - Phone:919-693-8801
Practice Address - Fax:919-693-2401
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19423183500000X
IL051299327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist