MEDICARE: ANNIE C MATHEW PHARM.D., CDE

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	1835P1200X	Pharmacotherapy Pharmacist	39676	TX

General Provider Information

NPI Number	:	1912990441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE C MATHEW PHARM.D., CDE

Provider Business Mailing Address
First Line	:	3044 PINON CANYON LN
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-3746
Country	:	US
Telephone Number	:	214-274-5614
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 HOPKINS ST
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75040-7379
Country	:	US
Telephone Number	:	214-266-0658
Fax Number	:	214-266-0656

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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