Active NPI
Shibu Mathew, R.PH
- Pharmacist
- Plano, TX
National Provider Identifier
1619577236
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 39021
- Practice address
- 8621 Ohio Dr
Plano, TX 75024-2264 - Phone
- (469) 633-0041
- Fax
- (469) 633-0043
- NPI assigned
- Nov 1, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 39021 | TX | Primary |
Addresses
Primary practice location
8621 Ohio Dr
Plano, TX 75024-2264
Mailing address
14672 Foxbriar LN
Frisco, TX 75035-1204
Phone (214) 402-5420
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39021 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604188800000",
"number": "1619577236",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14672 FOXBRIAR LN",
"city": "FRISCO",
"state": "TX",
"postal_code": "750351204",
"telephone_number": "214-402-5420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8621 OHIO DR",
"city": "PLANO",
"state": "TX",
"postal_code": "750242264",
"telephone_number": "469-633-0041",
"fax_number": "469-633-0043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHEW",
"first_name": "SHIBU",
"name_prefix": "Mr.",
"credential": "R.PH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-01",
"last_updated": "2020-11-01",
"certification_date": "2020-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "39021",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.