Provider Demographics
NPI:1902593585
Name:MED MATRIX PHARMACY, INC
Entity Type:Organization
Organization Name:MED MATRIX PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEP
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:760-536-3323
Mailing Address - Street 1:1929 W VISTA WAY STE G
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6003
Mailing Address - Country:US
Mailing Address - Phone:760-536-3323
Mailing Address - Fax:760-536-3513
Practice Address - Street 1:1929 W VISTA WAY STE G
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6003
Practice Address - Country:US
Practice Address - Phone:760-536-3323
Practice Address - Fax:760-536-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty