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General NPI Number Information
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NPI Number | 1902593585
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Entity Type | Organization
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Legal Business Name | MED MATRIX PHARMACY, INC
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 1929 W VISTA WAY STE G
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City | VISTA
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State | CA
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Zip | 92083-6003
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Country | US
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Telephone | 760-536-3323
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Fax | 760-536-3513
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Provider Business Mailing Address
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Address Line | 1929 W VISTA WAY STE G
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City | VISTA
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State | CA
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Zip | 92083-6003
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Country | US
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Telephone | 760-536-3323
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Fax | 760-536-3513
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Authorized Official
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Title or Position | CEP
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Name | CONNIE DAO
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Credential | PHARMD
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Telephone | 760-536-3323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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