Provider Demographics
NPI:1770202574
Name:MATOUSEK, KATHERINE (PHARMD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MATOUSEK
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 1:1649 CARMELLE CT
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2402
Mailing Address - Country:US
Mailing Address - Phone:440-334-4232
Mailing Address - Fax:
Practice Address - Street 1:7045 LIGHTHOUSE WAY
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-7000
Practice Address - Country:US
Practice Address - Phone:419-873-6836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034424331835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist