Provider Demographics
NPI:1811662448
Name:JOHN, SAJI MATHEW (RPH)
Entity type:Individual
Prefix:MR
First Name:SAJI
Middle Name:MATHEW
Last Name:JOHN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16184 MARIPOSA CIR N
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-4602
Mailing Address - Country:US
Mailing Address - Phone:954-242-6675
Mailing Address - Fax:
Practice Address - Street 1:1255 W 46TH ST STE 5
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3257
Practice Address - Country:US
Practice Address - Phone:786-359-4283
Practice Address - Fax:786-899-0980
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL42066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist