Provider Demographics
NPI:1336628825
Name:MATHENGE, PETER M
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:MATHENGE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:M
Other - Last Name:MATHENGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:818 RINGOLD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-6368
Mailing Address - Country:US
Mailing Address - Phone:281-513-2529
Mailing Address - Fax:
Practice Address - Street 1:818 RINGOLD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-6368
Practice Address - Country:US
Practice Address - Phone:281-260-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505541835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX50554Other50554