Provider Demographics
NPI:1346843240
Name:MATYJA, DENNIS MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:MICHAEL
Last Name:MATYJA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6231 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2912
Mailing Address - Country:US
Mailing Address - Phone:440-248-9239
Mailing Address - Fax:855-817-7772
Practice Address - Street 1:6231 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2912
Practice Address - Country:US
Practice Address - Phone:440-248-9239
Practice Address - Fax:855-817-7772
Is Sole Proprietor?:No
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist