Provider Demographics
NPI:1356812630
Name:FERNJI, MATEWOS J (PHARM D)
Entity type:Individual
Prefix:
First Name:MATEWOS
Middle Name:J
Last Name:FERNJI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 LAKEVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4532
Mailing Address - Country:US
Mailing Address - Phone:972-463-8224
Mailing Address - Fax:
Practice Address - Street 1:8801 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4532
Practice Address - Country:US
Practice Address - Phone:972-463-8224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-11
Last Update Date:2022-12-17
Deactivation Date:2019-01-26
Deactivation Code:
Reactivation Date:2020-07-08
Provider Licenses
StateLicense IDTaxonomies
TX55477183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist