Provider Demographics
NPI:1942022447
Name:MATRIX PHARMACY LATHRUP VILLAGE
Entity type:Organization
Organization Name:MATRIX PHARMACY LATHRUP VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANH
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-945-7506
Mailing Address - Street 1:26237 SOUTHFIELD RD STE B
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-4546
Mailing Address - Country:US
Mailing Address - Phone:734-945-7506
Mailing Address - Fax:
Practice Address - Street 1:26237 SOUTHFIELD RD STE B
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4546
Practice Address - Country:US
Practice Address - Phone:734-945-7506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy