MEDICARE: MATRIX PHARMACY, LLC

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
1	3336M0002X	Mail Order Pharmacy	PS20125	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1014531	OTHER		NCPDP-NABP

General Provider Information

NPI Number	:	1447302963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATRIX PHARMACY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 274070
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33688-4070
Country	:	US
Telephone Number	:	800-784-0882
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 BENJAMIN CENTER DR
Second Line	:	SUITE 103
City	:	TAMPA
State	:	FL
Zip	:	33634-5262
Country	:	US
Telephone Number	:	800-784-0882
Fax Number	:

Authorized Official
Title or Position	:	SR. VICE PRESIDENT
Name	:	MR. ALLEN P (PHIL) WALLS
Credential	:	R.PH.
Telephone Number	:	813-514-0494

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	03/07/2023

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Directions to “MATRIX PHARMACY, LLC ” Practice Location

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