Provider Demographics
NPI:1912545450
Name:MATHEWS, ALLEN
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 S MAIN ST STE 14
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5309
Mailing Address - Country:US
Mailing Address - Phone:832-615-3662
Mailing Address - Fax:832-478-1256
Practice Address - Street 1:4227 S MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5309
Practice Address - Country:US
Practice Address - Phone:832-615-3662
Practice Address - Fax:832-478-1256
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist