MEDICARE: ANJU S. MATHEW PHARM.D.

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
1	183500000X	Pharmacist	RP442531	PA

General Provider Information

NPI Number	:	1245386903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJU S. MATHEW PHARM.D.

Provider Business Mailing Address
First Line	:	9880 BUSTLETON AVE STE 332
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2144
Country	:	US
Telephone Number	:	215-827-1680
Fax Number	:	215-827-1394

Provider Business Practice Location Address
First Line	:	9880 BUSTLETON AVE STE 332
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2144
Country	:	US
Telephone Number	:	215-827-1680
Fax Number	:	215-827-1394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	09/02/2011

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