Individual provider Active NPI

Koshy Mathew, PHARMD, MBA, DAAPM

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Madison, MS
National Provider Identifier
1508311028
Registry record updated Aug 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X
License
P13348 Issued in MS
Practice address
122 McDill CV
Madison, MS 39110-6562
Phone
(224) 805-0156
Fax
(601) 988-1701
NPI assigned
Aug 25, 2016
Last updated
Aug 25, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 051040606 IL
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X P13348 MS Primary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 016949 KY
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 0000038112 TN
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X PST020543 LA
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X PD12676 AR
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 0014078 OR
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 22406 MD
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 14533 NE
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X S020551 AZ
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 0202213181 VA
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 54965 TX
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X PS52242 FL
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 17998 AL
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X 15851 OK

Addresses

Primary practice location

122 McDill CV
Madison, MS 39110-6562

Mailing address

122 McDill CV
Madison, MS 39110-6562
Phone (224) 805-0156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Business Administration, Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
22406MDMDClinical Social Worker
17998ALMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
PD12676ARMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
S020551AZMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
PS52242FLMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
051040606ILMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
016949KYMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
PST020543LAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
P13348MSMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
14533NEMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
15851OKMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
0014078ORMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
0000038112TNMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
0202213181VAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472083200000",
    "number": "1508311028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 MCDILL CV",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106562",
            "telephone_number": "224-805-0156",
            "fax_number": "601-988-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 MCDILL CV",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106562",
            "telephone_number": "224-805-0156",
            "fax_number": "601-988-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "KOSHY",
        "name_prefix": "Dr.",
        "credential": "PHARMD, MBA, DAAPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-25",
        "last_updated": "2016-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "IL",
            "license": "051040606",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "MS",
            "license": "P13348",
            "primary": true
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "KY",
            "license": "016949",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "TN",
            "license": "0000038112",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "LA",
            "license": "PST020543",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "AR",
            "license": "PD12676",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OR",
            "license": "0014078",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "MD",
            "license": "22406",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NE",
            "license": "14533",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "AZ",
            "license": "S020551",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "VA",
            "license": "0202213181",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "TX",
            "license": "54965",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "FL",
            "license": "PS52242",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "AL",
            "license": "17998",
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OK",
            "license": "15851",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.