Provider Demographics
NPI:1376564633
Name:HUMMAS INC
Entity Type:Organization
Organization Name:HUMMAS INC
Other - Org Name:HUMMAS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-524-4111
Mailing Address - Street 1:606 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1835
Mailing Address - Country:US
Mailing Address - Phone:618-524-4111
Mailing Address - Fax:618-524-4111
Practice Address - Street 1:606 MARKET ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1835
Practice Address - Country:US
Practice Address - Phone:618-524-4111
Practice Address - Fax:618-524-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
IL0540084473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1411216OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IL=========001Medicaid