Organization
MATOKE INCORPORATED SOUTHSIDE PHARMACY
Active
Other names
NORTHWEST PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC MATOKE RPH (PIC OWNER)
(972) 207-0247
Entity
Organization
Contact information
Practice address
14041 NORTHWEST BLVD, STE 2B, CORPUS CHRISTI, TX 78410-5137
(361) 767-1300
(361) 767-8888
Mailing address
14041 NORTHWEST BLVD, STE 2B, CORPUS CHRISTI, TX 78410-5137
(361) 767-1300
(361) 767-8888
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
25349
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145756
—
TX
01
—
4543648
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/03/2007
Last updated
03/12/2013
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