Mactor, Inc.

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

Legal business name

MACTOR, INC.

Doing business as

Provision Pharmacy

Practice address

4428 Glacier Ave
San Diego, CA 92120-3304

Phone

(916) 993-0212

NPI assigned

Feb 16, 2021

Organization subpart

No

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

Authorized official

Name

Mitesh Patel, PHARMD

Title

President

Phone

(619) 269-6600

Specialties & licenses 1

Addresses

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.

  • Community/Retail Pharmacy
  • San Diego, CA
  • NPI 1740214790
  NPD tax ID

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

{
    "created_epoch": "1613433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613433600000",
    "number": "1801489323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4428 GLACIER AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921203304",
            "telephone_number": "916-993-0212"
        },
        {
            "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": "916-993-0212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MACTOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-16",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "MITESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-269-6600",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PROVISION PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Brandy Diane Macy, PSYD

• Long Term Care Pharmacy in San Diego, CA
• Providers in San Diego, CA by specialty
• Long Term Care Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2021; 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.