Healthcare Provider Details

I. General information

NPI: 1205845898
Provider Name (Legal Business Name): MFMM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 W 177TH ST STE 1E
HAZEL CREST IL
60429-2184
US

IV. Provider business mailing address

3330 W 177TH ST STE 1E
HAZEL CREST IL
60429-2184
US

V. Phone/Fax

Practice location:
  • Phone: 708-798-4300
  • Fax: 708-798-4447
Mailing address:
  • Phone: 708-798-4300
  • Fax: 708-798-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054.015826
License Number StateIL

VIII. Authorized Official

Name: MARCEL JEAN
Title or Position: OWNER
Credential:
Phone: 708-798-4300