Provider Demographics
NPI:1134578982
Name:MATHEW, RONY (PHARMD,RPH)
Entity type:Individual
Prefix:MR
First Name:RONY
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:PHARMD,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1608
Mailing Address - Country:US
Mailing Address - Phone:516-238-7792
Mailing Address - Fax:
Practice Address - Street 1:10 MILES AVE
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1608
Practice Address - Country:US
Practice Address - Phone:516-238-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061484183500000X
NJ28RI03663400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist