Provider Demographics
NPI:1275899973
Name:MEDICATION MANAGEMENT SOLUTIONS LLC
Entity Type:Organization
Organization Name:MEDICATION MANAGEMENT SOLUTIONS LLC
Other - Org Name:MEDICATION MANAGEMENT SOLUTIONS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-387-7802
Mailing Address - Street 1:PO BOX 2457
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35502-2457
Mailing Address - Country:US
Mailing Address - Phone:205-387-7802
Mailing Address - Fax:888-855-8640
Practice Address - Street 1:2030 3RD AVE S
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-5807
Practice Address - Country:US
Practice Address - Phone:205-387-7802
Practice Address - Fax:888-855-8640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1138883336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL138137Medicaid
2135232OtherPK