Provider Demographics
NPI:1285037408
Name:DELAHUNTY, MATTHEW (PHARMD, BCPS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:DELAHUNTY
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 E BROAD ST
Mailing Address - Street 2:TB009
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1492 E BROAD ST
Practice Address - Street 2:TB009
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1546
Practice Address - Country:US
Practice Address - Phone:614-257-3170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032280761835P0018X
OH31103631835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy