Provider Demographics
NPI:1982074183
Name:MATHEW, PRASOBH
Entity Type:Individual
Prefix:
First Name:PRASOBH
Middle Name:
Last Name:MATHEW
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 1:1226 E DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-8856
Mailing Address - Country:US
Mailing Address - Phone:336-626-5675
Mailing Address - Fax:
Practice Address - Street 1:1226 E DIXIE DR
Practice Address - Street 2:1226 E DIXIE DR
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-8856
Practice Address - Country:US
Practice Address - Phone:336-626-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23952183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist