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NPI Code Detail

MEDICARE: PHARMATOX, INC.

MEDICARE: PHARMATOX, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency480016APCA

General Provider Information

NPI Number : 1174695241
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHARMATOX, INC.
Provider Business Mailing Address
First Line : 1143 MISSOURI ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6007
Country : US
Telephone Number : 707-435-8042
Fax Number : 707-435-1527
Provider Business Practice Location Address
First Line : 1143 MISSOURI ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6007
Country : US
Telephone Number : 707-435-8042
Fax Number : 707-435-1527
Authorized Official
Title or Position : DIRECTOR OF CLINICAL SERVICES
Name : DR. MICHAEL CLIFTON MEREDITH
Credential : PHD
Telephone Number : 707-435-8042
Provider Enumeration Date : 11/14/2006
Last Update Date : 08/22/2020

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Directions to “PHARMATOX, INC. ” Practice Location

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