Healthcare Provider Details

I. General information

NPI: 1346783529
Provider Name (Legal Business Name): JAMIE MATKOVIC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 METROHEALTH DR OUTPATIENT PLAZA PHARMACY
CLEVELAND OH
44109-1900
US

IV. Provider business mailing address

2500 METROHEALTH DR OUTPATIENT PLAZA PHARMACY
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-778-7297
  • Fax: 216-778-1055
Mailing address:
  • Phone: 216-778-7297
  • Fax: 216-778-1055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03125818
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: