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NPI Code Detail

MEDICARE: SOUMYA MATHEW

MEDICARE: SOUMYA MATHEW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051.292894IL

General Provider Information

NPI Number : 1083062061
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOUMYA MATHEW
Provider Business Mailing Address
First Line : 1340 S CANAL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-5208
Country : US
Telephone Number : 312-666-5612
Fax Number :
Provider Business Practice Location Address
First Line : 1340 S CANAL ST
Second Line :
City : CHICAGO
State : IL
Zip : 60607-5208
Country : US
Telephone Number : 312-666-5612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2016
Last Update Date : 05/31/2016

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Directions to “ SOUMYA MATHEW ” Practice Location

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