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General NPI Number Information
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NPI Number | 1851000426
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Entity Type | Individual
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Provider Name | JUSTIN REJI MATHEW PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/22/2022
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 975 KIRMAN AVE
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City | RENO
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State | NV
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Zip | 89502-0997
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Country | US
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Telephone | 888-838-6256
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Fax |
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Provider Business Mailing Address
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Address Line | 2255 SPRING HARBOR DR APT O
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City | DELRAY BEACH
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State | FL
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Zip | 33445-6934
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Country | US
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Telephone | 954-305-2721
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 62706
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License Number State | FL
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