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General NPI Number Information
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NPI Number | 1740214790
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Entity Type | Organization
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Legal Business Name | MACTOR, INC.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/04/2020
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Provider Practice Location Address
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Address Line | 4428 GLACIER AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-3304
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Country | US
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Telephone | 619-466-3246
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Fax | 619-466-4134
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Provider Business Mailing Address
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Address Line | 11676 TREADWELL DR
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 619-466-3246
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Fax | 619-466-4134
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Authorized Official
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Title or Position | CEO
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Name | MITESH PATEL
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Credential | PHARM D
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Telephone | 619-466-3246
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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 | 56091
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License Number State | CA
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