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General NPI Number Information
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NPI Number | 1740512094
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Entity Type | Organization
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Legal Business Name | MEDICATION MANAGEMENT PARTNERS
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 13601 KENTON AVE
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City | CRESTWOOD
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State | IL
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Zip | 60418-1938
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Country | US
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Telephone | 708-752-8000
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Fax | 708-752-8011
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Provider Business Mailing Address
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Address Line | 13601 KENTON AVE
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City | CRESTWOOD
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State | IL
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Zip | 60418-1938
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Country | US
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Telephone | 708-752-8000
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Fax | 708-752-8011
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Authorized Official
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Title or Position | CEO/PHARMACIST
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Name | LABINOT AVDIU
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Credential | PHARM D
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Telephone | 708-752-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 054016830
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License Number State | IL
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