MEDICARE: PHARMATOX, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	480016AP	CA

General Provider Information

NPI Number	:	1174695241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMATOX, INC.

Provider Business Mailing Address
First Line	:	1143 MISSOURI ST
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6007
Country	:	US
Telephone Number	:	707-435-8042
Fax Number	:	707-435-1527

Provider Business Practice Location Address
First Line	:	1143 MISSOURI ST
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6007
Country	:	US
Telephone Number	:	707-435-8042
Fax Number	:	707-435-1527

Authorized Official
Title or Position	:	DIRECTOR OF CLINICAL SERVICES
Name	:	DR. MICHAEL CLIFTON MEREDITH
Credential	:	PHD
Telephone Number	:	707-435-8042

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	08/22/2020

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Directions to “PHARMATOX, INC. ” Practice Location

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