Provider Demographics
NPI:1831468560
Name:MATHAI, BEENA JOSEPH (BS IN PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:BEENA
Middle Name:JOSEPH
Last Name:MATHAI
Suffix:
Gender:F
Credentials:BS IN PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 S KIRKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7915
Mailing Address - Country:US
Mailing Address - Phone:407-248-0315
Mailing Address - Fax:407-248-2297
Practice Address - Street 1:5501 S KIRKMAN RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7915
Practice Address - Country:US
Practice Address - Phone:407-248-0315
Practice Address - Fax:407-248-2297
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 38082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist