Provider Demographics
NPI:1093795577
Name:MED MATRIX PHARMACY, INC
Entity type:Organization
Organization Name:MED MATRIX PHARMACY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-758-7650
Mailing Address - Street 1:161 THUNDER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6051
Mailing Address - Country:US
Mailing Address - Phone:760-758-7650
Mailing Address - Fax:760-758-8228
Practice Address - Street 1:161 THUNDER DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6016
Practice Address - Country:US
Practice Address - Phone:760-758-7650
Practice Address - Fax:760-758-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2127529OtherPK
2127529OtherPK