Healthcare Provider Details

I. General information

NPI: 1487088456
Provider Name (Legal Business Name): MATTHEW ALEXANDER KOWALSKI PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25524 CENTER RIDGE RD
WESTLAKE OH
44145-4048
US

IV. Provider business mailing address

25524 CENTER RIDGE RD
WESTLAKE OH
44145-4048
US

V. Phone/Fax

Practice location:
  • Phone: 440-892-0525
  • Fax:
Mailing address:
  • Phone: 440-892-0525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03233235
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: