Healthcare Provider Details

I. General information

NPI: 1639061369
Provider Name (Legal Business Name): MATTHEW THOMAS HOTEK PHARMD, MHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201-5351
US

IV. Provider business mailing address

2400 17TH ST
COLUMBUS IN
47201-5351
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5239
  • Fax:
Mailing address:
  • Phone: 812-376-5239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26019927A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: