Healthcare Provider Details

I. General information

NPI: 1215665526
Provider Name (Legal Business Name): ASHLEY MATALON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 EQUITY DR STE A
COLUMBUS OH
43228-3842
US

IV. Provider business mailing address

4343 EQUITY DR STE A
COLUMBUS OH
43228-3842
US

V. Phone/Fax

Practice location:
  • Phone: 833-614-4438
  • Fax:
Mailing address:
  • Phone: 833-614-4438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03442397
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: