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PROVISION PHARMACY
NPI 1740214790
Pharmacy - Community/Retail Pharmacy in San Diego, CA

Active since July 10, 2006
4428 GLACIER AVE, SAN DIEGO, CA 92120(619) 466-3246(619) 466-4134 Get Directions Write a Review

NPPES record last updated: March 4, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 4, 2020, May 10, 2018 (2 updates tracked since 2018).

About Provision Pharmacy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVISION PHARMACY (NPI 1740214790) is a healthcare organization registered as a community/retail pharmacy in San Diego, California and active in the NPI registry since July 2006. The organization lists Mitesh Patel, Ceo, as its authorized official.

NPPES Registry Identity

NPI1740214790
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameMACTOR, INC.
Location Address4428 GLACIER AVESan Diego, CA 92120-3304
Mailing Address11676 Treadwell DrPoway, CA 92064 · (619) 466-3246 · Fax (619) 466-4134
Phone(619) 466-3246
Fax(619) 466-4134
Organization SubpartNo
Authorized OfficialMitesh PatelCeo · (619) 466-3246
Enumeration DateJuly 10, 2006
Last NPPES UpdateMarch 4, 20202 updates tracked since enumeration
NPPES CertifiedMarch 4, 2020
✔ NPI 1740214790 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in CA · 56091
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
4428 GLACIER AVE, San Diego, CA 92120
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Other Names 1

Doing Business AsProvision Pharmacy

Other Identifiers 2

MedicaidPHA466130CA
Other0534342Ncpdp

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PROVISION PHARMACY, INC.
Pharmacy (Community/Retail Pharmacy)
4428 GLACIER AVE
SAN DIEGO, CA 92120
San Diego County (808) 854-8999
MACTOR, INC.
Pharmacy (Long Term Care Pharmacy)
4428 GLACIER AVE
SAN DIEGO, CA 92120
San Diego County (916) 993-0212
PROVISION PHARMACY, INC. -LTC
Pharmacy (Long Term Care Pharmacy)
4428 GLACIER AVE
SAN DIEGO, CA 92120
San Diego County (808) 854-8999

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mactor, Inc.'s NPI number?

The NPI number for Mactor, Inc. is 1740214790. It was assigned to this organization in the NPPES registry on July 10, 2006. The provider is doing business as Provision Pharmacy.

Where is Mactor, Inc. located?

Mactor, Inc. is located at 4428 Glacier Ave, San Diego, CA 92120. The listed phone number is (619) 466-3246.

What is Mactor, Inc.'s specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

What insurance does Mactor, Inc. accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 47 other insurers list Mactor, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mactor, Inc. was last updated on March 4, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.