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General NPI Number Information
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NPI Number | 1275615221
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Entity Type | Organization
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Legal Business Name | M.A.M.T., LLC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 1022 E GRIFFIN PKWY STE 103
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City | MISSION
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State | TX
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Zip | 78572-2401
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Country | US
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Telephone | 956-581-5646
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Fax | 956-581-8038
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Provider Business Mailing Address
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Address Line | 1022 E GRIFFIN PKWY STE 103
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City | MISSION
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State | TX
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Zip | 78572-2401
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Country | US
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Telephone | 956-581-5646
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | NIDIA VILLARREAL
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Credential |
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Telephone | 956-581-5646
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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 | 19059
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License Number State | TX
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