Provider Demographics
NPI:1811500499
Name:MATHEW, BINI MARIA (REGISTERED PHARMACIS)
Entity type:Individual
Prefix:
First Name:BINI MARIA
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:REGISTERED PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 MADISON ST APT 103
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2529
Mailing Address - Country:US
Mailing Address - Phone:407-923-8797
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVE NW STE 1107
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-987-1467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202218490183500000X
DCPH100003543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist