Provider Demographics
NPI:1881977940
Name:MATHAI, LIGI A
Entity type:Individual
Prefix:MRS
First Name:LIGI
Middle Name:A
Last Name:MATHAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5542 ALBIN DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5976
Mailing Address - Country:US
Mailing Address - Phone:561-641-8730
Mailing Address - Fax:
Practice Address - Street 1:4998 10TH AVE N
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-2210
Practice Address - Country:US
Practice Address - Phone:561-649-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist