Healthcare Provider Details

I. General information

NPI: 1942977905
Provider Name (Legal Business Name): SUMMER ALI MATAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 W MARKET ST
FAIRLAWN OH
44333-3606
US

IV. Provider business mailing address

3234 RIDGEWOOD RD
FAIRLAWN OH
44333-3116
US

V. Phone/Fax

Practice location:
  • Phone: 330-867-8492
  • Fax:
Mailing address:
  • Phone: 330-697-3949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03441116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: