Healthcare Provider Details

I. General information

NPI: 1548183569
Provider Name (Legal Business Name): KRISTIN MATICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11911 N MERIDIAN ST
CARMEL IN
46032-6904
US

IV. Provider business mailing address

2272 MOON SHADOW LN
CARMEL IN
46280-1733
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-0717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26020372A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: