Provider Demographics
NPI:1154750198
Name:MATIN, BIZHAN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:BIZHAN
Middle Name:
Last Name:MATIN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-4336
Mailing Address - Country:US
Mailing Address - Phone:614-547-2201
Mailing Address - Fax:
Practice Address - Street 1:1645 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4336
Practice Address - Country:US
Practice Address - Phone:614-547-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232608183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist