MEDICARE: BINDU MATHEW RPH

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	RP045519L	PA

General Provider Information

NPI Number	:	1821317140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BINDU MATHEW RPH

Provider Business Mailing Address
First Line	:	9307 LARAMIE RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2737
Country	:	US
Telephone Number	:	267-977-8259
Fax Number	:

Provider Business Practice Location Address
First Line	:	11750 BUSTLETON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-2516
Country	:	US
Telephone Number	:	215-934-6221
Fax Number	:

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

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	05/26/2010

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