Organization
MATT'S RX,LLC
Active
Other names
Matt's Medicine Store
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MATTHEW MALLINSON (MEMBER)
(816) 833-3636
Entity
Organization
Contact information
Practice address
11200 1-2 E US HIGHWAY 24, INDEPENDENCE, MO 64054-1514
(816) 833-3636
(816) 833-1071
Mailing address
11200 1-2 E US HIGHWAY 24, INDEPENDENCE, MO 64054-1514
(816) 833-3636
(816) 833-1071
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
004747
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
602442402
—
MO
05
—
622442408
—
MO
Enumeration date
06/04/2006
Last updated
12/08/2009
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