Provider Demographics
NPI:1770183139
Name:MATHEW, GINU (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GINU
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SILVERBIRCH RD
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-3017
Mailing Address - Country:US
Mailing Address - Phone:781-330-6788
Mailing Address - Fax:
Practice Address - Street 1:780 LYNNWAY
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-3061
Practice Address - Country:US
Practice Address - Phone:781-592-4330
Practice Address - Fax:781-592-9018
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH233590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist