Healthcare Provider Details

I. General information

NPI: 1376564633
Provider Name (Legal Business Name): HUMMAS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 MARKET ST
METROPOLIS IL
62960-1835
US

IV. Provider business mailing address

606 MARKET ST
METROPOLIS IL
62960-1835
US

V. Phone/Fax

Practice location:
  • Phone: 618-524-4111
  • Fax: 618-524-4111
Mailing address:
  • Phone: 618-524-4111
  • Fax: 618-524-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number054008447
License Number StateIL

VIII. Authorized Official

Name: DAVID MARTIN
Title or Position: PHARMACIST
Credential:
Phone: 618-524-4111