MEDICARE: MR. MATHEWS SKARIAH PEEDIKAMALAYIL B PHARM

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	RP443901	PA

General Provider Information

NPI Number	:	1245539311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MATHEWS SKARIAH PEEDIKAMALAYIL B PHARM

Provider Business Mailing Address
First Line	:	2103 N 3RD ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-1812
Country	:	US
Telephone Number	:	717-236-4208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 N 3RD ST
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17110-1812
Country	:	US
Telephone Number	:	717-236-4208
Fax Number	:

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

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	03/15/2011

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