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General NPI Number Information
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NPI Number | 1205845898
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Entity Type | Organization
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Legal Business Name | MFMM INC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/12/2016
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Provider Practice Location Address
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Address Line | 3330 W 177TH ST STE 1E
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City | HAZEL CREST
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State | IL
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Zip | 60429-2184
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Country | US
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Telephone | 708-798-4300
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Fax | 708-798-4447
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Provider Business Mailing Address
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Address Line | 3330 W 177TH ST STE 1E
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City | HAZEL CREST
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State | IL
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Zip | 60429-2184
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Country | US
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Telephone | 708-798-4300
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Fax | 708-798-4447
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Authorized Official
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Title or Position | OWNER
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Name | MARCEL JEAN
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Credential |
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Telephone | 708-798-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054.015826
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License Number State | IL
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