Provider Demographics
NPI:1083058309
Name:MATDAN LJ, INC
Entity Type:Organization
Organization Name:MATDAN LJ, INC
Other - Org Name:MERCY CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:BASSAM
Authorized Official - Middle Name:HANNA
Authorized Official - Last Name:MASSAAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:858-336-3624
Mailing Address - Street 1:2401 SOLEDAD CT
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7041
Mailing Address - Country:US
Mailing Address - Phone:858-336-3624
Mailing Address - Fax:
Practice Address - Street 1:488 E VALLEY PKWY STE 101
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3324
Practice Address - Country:US
Practice Address - Phone:760-294-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy