Provider Demographics
NPI:1588198279
Name:MATTHEWS, KATHERINE M (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 ASPIRA CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4125
Mailing Address - Country:US
Mailing Address - Phone:419-774-3121
Mailing Address - Fax:419-774-3140
Practice Address - Street 1:1125 ASPIRA CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4125
Practice Address - Country:US
Practice Address - Phone:419-774-3121
Practice Address - Fax:419-774-3140
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03233135183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist