Provider Demographics
NPI:1760897474
Name:MATTATHIL PURAYIDATHIL CHERIAN, AJITH (PHARMD)
Entity Type:Individual
Prefix:
First Name:AJITH
Middle Name:
Last Name:MATTATHIL PURAYIDATHIL CHERIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:MR
Other - First Name:AJITH
Other - Middle Name:
Other - Last Name:CHERIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:30 EDWARDS RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2201
Mailing Address - Country:US
Mailing Address - Phone:973-572-3137
Mailing Address - Fax:
Practice Address - Street 1:47 HOPATCHUNG RD
Practice Address - Street 2:
Practice Address - City:HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07843
Practice Address - Country:US
Practice Address - Phone:973-398-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03541400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist