Healthcare Provider Details

I. General information

NPI: 1912155011
Provider Name (Legal Business Name): MATTHEW ALAN KUBIAK PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BOULEVARD
CLEVELAND OH
44106
US

IV. Provider business mailing address

1420 OAKWOOD TRL
PAINESVILLE OH
44077-7615
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax:
Mailing address:
  • Phone: 216-791-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number011906
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: