Individual
MARK IRA VAN MATRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
230 LAFAYETTE ST, LONDON, OH 43140-9059
(740) 852-7550
(740) 852-7551
Mailing address
124 REGENCY DR, CEDARVILLE, OH 45314-9501
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
03445796
OH
Other
Enumeration date
08/14/2025
Last updated
08/14/2025
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