Organization
MACTOR, INC.
Active
Other names
PROVISION PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MITESH PATEL PHARMD (PRESIDENT)
(619) 269-6600
Entity
Organization
Contact information
Practice address
4428 GLACIER AVE, SAN DIEGO, CA 92120-3304
(916) 993-0212
Mailing address
4428 GLACIER AVE, SAN DIEGO, CA 92120-3304
(916) 993-0212
Taxonomy
Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
02/16/2021
Last updated
02/16/2021
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