Mactor, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

56091 Issued in CA

Legal business name

MACTOR, INC.

Doing business as

Provision Pharmacy

Practice address

4428 Glacier Ave
San Diego, CA 92120-3304

Phone

(619) 466-3246

Fax

(619) 466-4134

NPI assigned

Jul 10, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mitesh Patel, PHARM D

Title

Ceo

Phone

(619) 466-3246

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Provision Pharmacy Doing business as

Tax ID family

Mactor Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mactor, Inc.

  • Long Term Care Pharmacy
  • San Diego, CA
  • NPI 1801489323
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth V Sison

  • Pharmacy Technician
  • La Mesa, CA
  • NPI 1578830568
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1740214790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11676 TREADWELL DR",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "92064",
            "telephone_number": "619-466-3246",
            "fax_number": "619-466-4134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4428 GLACIER AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921203304",
            "telephone_number": "619-466-3246",
            "fax_number": "619-466-4134"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACTOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MITESH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-466-3246",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "56091",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA466130",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0534342",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provision Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ann Seeley Macquarrie, MD
• Mandi Leigh Macqueen
• Genevieve Macroberts
• Thomas Rumann Macsay, ND
• Dasha Witch-Hazel Mactavish
• Mactor, Inc.
• Neal W. Macudzinski, O.D.
• Megan Maculsay
• Arthur J. Macwhinnie
• Macy Psychology, Inc

• Community/Retail Pharmacy in San Diego, CA
• Providers in San Diego, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.