Provider Demographics
NPI:1891249082
Name:MATHEW, PAIGE (PHARMD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:MATHEW
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 N CENTRAL AVE
Mailing Address - Street 2:UNIT 14J
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4750 N CENTRAL AVE
Practice Address - Street 2:UNIT 14J
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1732
Practice Address - Country:US
Practice Address - Phone:206-939-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS021931183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist