Healthcare Provider Details

I. General information

NPI: 1285037408
Provider Name (Legal Business Name): MATTHEW DELAHUNTY PHARMD, BCPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 E BROAD ST TB009
COLUMBUS OH
43205-1546
US

IV. Provider business mailing address

1492 E BROAD ST TB009
COLUMBUS OH
43205-1546
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-3170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number3110363
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03228076
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: