Provider Demographics
NPI:1356623524
Name:SODER, MATTHEW D (RPH)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:SODER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # JJ1-201G
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0195
Mailing Address - Country:US
Mailing Address - Phone:216-445-5614
Mailing Address - Fax:216-445-0025
Practice Address - Street 1:9500 EUCLID AVE # JJ1-201G
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0195
Practice Address - Country:US
Practice Address - Phone:216-445-5614
Practice Address - Fax:216-445-0025
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03122309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist