Provider Demographics
NPI:1972122927
Name:MATRIX RX LLC
Entity Type:Organization
Organization Name:MATRIX RX LLC
Other - Org Name:MATRIX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZZOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-298-2054
Mailing Address - Street 1:3775B TRUEMAN CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-2496
Mailing Address - Country:US
Mailing Address - Phone:614-362-7242
Mailing Address - Fax:
Practice Address - Street 1:3775B TRUEMAN CT
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2496
Practice Address - Country:US
Practice Address - Phone:614-362-7242
Practice Address - Fax:614-362-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-09
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy