Healthcare Provider Details

I. General information

NPI: 1699690784
Provider Name (Legal Business Name): TORI MATTISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 N MACARTHUR BLVD
IRVING TX
75038-6412
US

IV. Provider business mailing address

324 COUNTY ROAD 3646
SULPHUR SPRINGS TX
75482-1629
US

V. Phone/Fax

Practice location:
  • Phone: 972-993-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77346
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: