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General NPI Number Information
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NPI Number | 1710995782
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Entity Type | Organization
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Legal Business Name | MATCH POINT, INC.
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12095 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-2626
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Country | US
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Telephone | 310-391-5238
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Fax | 310-391-0359
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Provider Business Mailing Address
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Address Line | 12095 W WASHINGTON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-2626
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Country | US
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Telephone | 310-391-5238
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Fax | 310-391-0359
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Authorized Official
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Title or Position | PRESIDENT/PHARMACIST
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Name | DR. DIMITRY BIGUN
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Credential | PHARM.D.
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Telephone | 310-344-3462
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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 | PHY46074
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License Number State | CA
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