=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710503644
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW ENGLEHART PHARM D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2020
-----------------------------------------------------
Last Update Date | 06/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 663 E AURORA RD
-----------------------------------------------------
City | MACEDONIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44056-2729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-468-4800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4260 LEEWOOD RD
-----------------------------------------------------
City | STOW
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44224-2519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03-2-37451
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------