Provider Demographics
NPI:1912050568
Name:MATHENY, JOHN M (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:MATHENY
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 1:348B COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2657
Mailing Address - Country:US
Mailing Address - Phone:803-957-5969
Mailing Address - Fax:803-808-1829
Practice Address - Street 1:348B COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2657
Practice Address - Country:US
Practice Address - Phone:803-957-5969
Practice Address - Fax:803-808-1829
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist