Provider Demographics
NPI:1780965707
Name:MATHEW, ANISH (RPH)
Entity type:Individual
Prefix:MR
First Name:ANISH
Middle Name:
Last Name:MATHEW
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13561 TENBURY WELLS WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4760
Mailing Address - Country:US
Mailing Address - Phone:407-573-0237
Mailing Address - Fax:
Practice Address - Street 1:1600 US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-5890
Practice Address - Country:US
Practice Address - Phone:352-242-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist