Organization
MATOKE INCORPORATED SOUTHSIDE PHARMACY
Active
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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