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General NPI Number Information
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NPI Number | 1942022447
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Entity Type | Organization
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Legal Business Name | MATRIX PHARMACY LATHRUP VILLAGE
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Dates
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Enumeration Date | 10/28/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 26237 SOUTHFIELD RD STE B
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-4546
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Country | US
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Telephone | 734-945-7506
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Fax |
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Provider Business Mailing Address
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Address Line | 26237 SOUTHFIELD RD STE B
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-4546
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Country | US
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Telephone | 734-945-7506
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Fax |
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Authorized Official
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Title or Position | PARTNER/PHARMACIST
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Name | MRS. ANH NGUYEN
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Credential | R.PH
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Telephone | 734-945-7506
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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 |
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License Number State |
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