Provider Demographics
NPI:1811281157
Name:MATHEWS, JUDY ANNE (RPH)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANNE
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 BOSQUE BLVD
Mailing Address - Street 2:TARGET 1531
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-4442
Mailing Address - Country:US
Mailing Address - Phone:254-399-9140
Mailing Address - Fax:254-399-9140
Practice Address - Street 1:5401 BOSQUE BLVD
Practice Address - Street 2:TARGET 1531
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4442
Practice Address - Country:US
Practice Address - Phone:254-399-9140
Practice Address - Fax:254-399-9140
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist