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General NPI Number Information
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NPI Number | 1760656987
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Entity Type | Organization
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Legal Business Name | MTM SERVICES
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Dates
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Enumeration Date | 04/18/2008
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Last Update Date | 04/18/2008
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Provider Practice Location Address
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Address Line | 1524 S SANGAMON ST UNIT 512
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City | CHICAGO
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State | IL
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Zip | 60608-2268
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Country | US
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Telephone | 312-850-2415
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Fax | 312-850-2415
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Provider Business Mailing Address
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Address Line | 1524 S SANGAMON ST UNIT 512
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City | CHICAGO
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State | IL
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Zip | 60608-2268
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Country | US
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Telephone | 312-850-2415
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Fax | 312-850-2415
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL T MA
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Credential | PHARM.D.
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Telephone | 312-420-5556
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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 | IL
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