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NPI Code Detail

MEDICARE: MATTHEW VIBBERT PHARMD, RPH

MEDICARE: MATTHEW VIBBERT PHARMD, RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist03230506-2OH

General Provider Information

NPI Number : 1356627731
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW VIBBERT PHARMD, RPH
Provider Business Mailing Address
First Line : 13585 S PARTRIDGE DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44125-5488
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20200 VAN AKEN BLVD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-3623
Country : US
Telephone Number : 216-751-4521
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2011
Last Update Date : 10/28/2011

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