Healthcare Provider Details

I. General information

NPI: 1821317140
Provider Name (Legal Business Name): BINDU MATHEW RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BUSTLETON AVE
PHILADELPHIA PA
19116-2516
US

IV. Provider business mailing address

9307 LARAMIE RD
PHILADELPHIA PA
19115-2737
US

V. Phone/Fax

Practice location:
  • Phone: 215-934-6221
  • Fax:
Mailing address:
  • Phone: 267-977-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP045519L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: