Provider Demographics
NPI:1700223526
Name:MATRX PHARMACY, LLC
Entity Type:Organization
Organization Name:MATRX PHARMACY, LLC
Other - Org Name:MATRX LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-863-3009
Mailing Address - Street 1:1030 AVENUE D
Mailing Address - Street 2:STE 2
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2086
Mailing Address - Country:US
Mailing Address - Phone:360-863-3009
Mailing Address - Fax:360-217-7570
Practice Address - Street 1:1030 AVENUE D
Practice Address - Street 2:STE 2
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2086
Practice Address - Country:US
Practice Address - Phone:360-863-3009
Practice Address - Fax:360-217-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
WAPHAR.CF.603652553336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140751OtherPK