Provider Demographics
NPI:1063811867
Name:MATHEWS, ANIA (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:ANIA
Middle Name:
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 ELK ST
Mailing Address - Street 2:SOUTH LINCOLN MEDICAL CENTER
Mailing Address - City:KEMMERER
Mailing Address - State:WY
Mailing Address - Zip Code:83101
Mailing Address - Country:US
Mailing Address - Phone:307-877-4401
Mailing Address - Fax:307-828-9073
Practice Address - Street 1:711 ONYX ST
Practice Address - Street 2:
Practice Address - City:KEMMERER
Practice Address - State:WY
Practice Address - Zip Code:83101-3214
Practice Address - Country:US
Practice Address - Phone:307-877-4401
Practice Address - Fax:307-828-9073
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP0008208183500000X
WY3803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist