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General NPI Number Information
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NPI Number | 1295920403
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Entity Type | Organization
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Legal Business Name | MATRIX RX
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 1124 MACE AVE
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City | BALTIMORE
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State | MD
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Zip | 21221-3315
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Country | US
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Telephone | 443-600-7466
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 FOXRIDGE LN
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City | BALTIMORE
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State | MD
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Zip | 21221-5914
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Country | US
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Telephone | 443-600-7466
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SHERRI FUGET
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Credential | C.M.T.
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Telephone | 443-600-7466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | M03406
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License Number State | MD
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