Provider Demographics
NPI:1205120565
Name:MATSKO, JESSICA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:MATSKO
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 1:1285 SOM CENTER RD
Mailing Address - Street 2:T-1324
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2073
Mailing Address - Country:US
Mailing Address - Phone:440-995-9919
Mailing Address - Fax:
Practice Address - Street 1:1285 SOM CENTER RD
Practice Address - Street 2:T-1324
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2073
Practice Address - Country:US
Practice Address - Phone:440-995-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist