Provider Demographics
NPI:1952071243
Name:MATRIX VIP LLC
Entity Type:Organization
Organization Name:MATRIX VIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:412-608-0515
Mailing Address - Street 1:2124 PENN AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-4410
Mailing Address - Country:US
Mailing Address - Phone:412-586-4545
Mailing Address - Fax:
Practice Address - Street 1:2124 PENN AVE STE 301
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-4410
Practice Address - Country:US
Practice Address - Phone:412-586-4545
Practice Address - Fax:412-904-2768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy