Provider Demographics
NPI:1922036300
Name:MATHES PHARMACY INC
Entity Type:Organization
Organization Name:MATHES PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:812-944-3612
Mailing Address - Street 1:1621 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150
Mailing Address - Country:US
Mailing Address - Phone:812-944-3612
Mailing Address - Fax:812-941-7303
Practice Address - Street 1:1621 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-3339
Practice Address - Country:US
Practice Address - Phone:812-944-3612
Practice Address - Fax:812-941-7303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
IN60002254333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100295750Medicaid
0544510001Medicare ID - Type Unspecified
IN100295750Medicaid
IN258380Medicare PIN