Healthcare Provider Details

I. General information

NPI: 1700223526
Provider Name (Legal Business Name): MATRX PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 AVENUE D STE 2
SNOHOMISH WA
98290-2086
US

IV. Provider business mailing address

1030 AVENUE D STE 2
SNOHOMISH WA
98290-2086
US

V. Phone/Fax

Practice location:
  • Phone: 360-863-3009
  • Fax: 360-217-7570
Mailing address:
  • Phone: 360-863-3009
  • Fax: 360-217-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHAR.CF.60365255
License Number StateWA

VIII. Authorized Official

Name: JANET KUSLER
Title or Position: PHARMACIST
Credential:
Phone: 360-863-3009