Mark Ira Van Matre

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

03445796 Issued in OH

Practice address

230 Lafayette St
London, OH 43140-9059

Phone

(740) 852-7550

Fax

(740) 852-7551

NPI assigned

Aug 14, 2025

Last updated

Aug 14, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • London, OH
  • NPI 1750315453
  NPD (past)
• Kroger Co

  dba Kroger Drugstore #622

  • Community/Retail Pharmacy
  • Bethlehem, GA
  • NPI 1154294205
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1755129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755129600000",
    "number": "1396621306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 REGENCY DR",
            "city": "CEDARVILLE",
            "state": "OH",
            "postal_code": "453149501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 LAFAYETTE ST",
            "city": "LONDON",
            "state": "OH",
            "postal_code": "431409059",
            "telephone_number": "740-852-7550",
            "fax_number": "740-852-7551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN MATRE",
        "first_name": "MARK",
        "middle_name": "IRA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-14",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "OH",
            "license": "03445796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Kathryn Trowbridge, D.O.
• Ainsley Tucker, CT
• Lauren Nicole Tucker, PA-C
• Morgan Turnbull, OTD, OTR/L
• Mary Elizabeth Tussing
• Ryan Van Pelt, LPC
• Vaughn Charles Darding
• Voca Corp
• Julie Ann Wagner, OTA-L
• Rylie Wahl

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in London, OH
• Providers in London, OH by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.