Healthcare Provider Details

I. General information

NPI: 1700716149
Provider Name (Legal Business Name): MED MATRIX PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 THUNDER DR STE 100
VISTA CA
92083-6051
US

IV. Provider business mailing address

161 THUNDER DR STE 100
VISTA CA
92083-6051
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-7650
  • Fax:
Mailing address:
  • Phone: 760-758-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CONNIE K DAO
Title or Position: OWNER
Credential: PHARMD
Phone: 760-758-7650