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General NPI Number Information
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NPI Number | 1952548521
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Entity Type | Organization
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Legal Business Name | PHARMTOX
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 01/19/2009
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Provider Practice Location Address
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Address Line | 980 ENCHANTED WAY
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City | SIMI VALLEY
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State | CA
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Zip | 93065-0911
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Country | US
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Telephone | 805-522-9274
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Fax |
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Provider Business Mailing Address
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Address Line | 1464 MADERA RD # N-181
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City | SIMI VALLEY
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State | CA
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Zip | 93065-3077
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Country | US
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Telephone | 805-522-9274
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Fax | 805-522-9374
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Authorized Official
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Title or Position | MBR
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Name | MR. MATT WALK
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Credential |
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Telephone | 805-522-9274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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