Individual
JAYA MARY MATHAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2045 SOUTH BLVD W, TROY, MI 48098-6540
(248) 879-8322
Mailing address
2045 SOUTH BLVD W, TROY, MI 48098-6540
(248) 879-8322
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
5315114492
MI
Other
Enumeration date
02/04/2020
Last updated
02/04/2020
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