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General NPI Number Information
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NPI Number | 1073551495
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Entity Type | Organization
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Legal Business Name | MATT'S RX,LLC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 11200 1-2 E US HIGHWAY 24
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City | INDEPENDENCE
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State | MO
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Zip | 64054-1514
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Country | US
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Telephone | 816-833-3636
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Fax | 816-833-1071
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Provider Business Mailing Address
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Address Line | 11200 1-2 E US HIGHWAY 24
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City | INDEPENDENCE
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State | MO
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Zip | 64054-1514
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Country | US
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Telephone | 816-833-3636
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Fax | 816-833-1071
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Authorized Official
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Title or Position | MEMBER
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Name | CHARLES MATTHEW MALLINSON
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Credential |
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Telephone | 816-833-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 004747
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License Number State | MO
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