MEDICARE: MMP RX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1598518235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMP RX, LLC

Provider Business Mailing Address
First Line	:	2391 RICHMOND AVE STE 3
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3906
Country	:	US
Telephone Number	:	718-285-8595
Fax Number	:	718-285-6677

Provider Business Practice Location Address
First Line	:	2391 RICHMOND AVE STE 3
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3906
Country	:	US
Telephone Number	:	718-285-8595
Fax Number	:	718-285-6677

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER MESHREKY
Credential	:	PHARMD
Telephone Number	:	718-285-8595

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	07/01/2024

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