=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679118038
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATRIX CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2019
-----------------------------------------------------
Last Update Date | 01/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3839 MINNESOTA AVE NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20019-2660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-388-1900
-----------------------------------------------------
Fax | 202-388-8099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3839 MINNESOTA AVE NE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20019-2660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-388-1900
-----------------------------------------------------
Fax | 202-388-8099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. TITILAYO AKINYOYENU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-388-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------