Healthcare Provider Details

I. General information

NPI: 1780204446
Provider Name (Legal Business Name): MATTHEW ELICK RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 EAST AVE
TALLMADGE OH
44278-2340
US

IV. Provider business mailing address

63 GLENWOOD CIR
TALLMADGE OH
44278-3072
US

V. Phone/Fax

Practice location:
  • Phone: 330-633-1150
  • Fax:
Mailing address:
  • Phone: 330-388-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03330888
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: