Provider Demographics
NPI:1164412953
Name:M & M PHARMACY LLC
Entity Type:Organization
Organization Name:M & M PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMASICT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:
Authorized Official - Last Name:IGIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM
Authorized Official - Phone:718-997-8200
Mailing Address - Street 1:10104 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2749
Mailing Address - Country:US
Mailing Address - Phone:718-997-8200
Mailing Address - Fax:718-997-8080
Practice Address - Street 1:10104 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2749
Practice Address - Country:US
Practice Address - Phone:718-997-8200
Practice Address - Fax:718-997-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026169332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3333856OtherNABP #
NY02426057Medicaid
NY026169OtherNYS LICENSE
NY02426057Medicaid