Provider Demographics
NPI:1518542653
Name:MMC PHARMACY INC
Entity Type:Organization
Organization Name:MMC PHARMACY INC
Other - Org Name:MILL RUN COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTOCKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:814-337-6600
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-337-6600
Mailing Address - Fax:814-337-6607
Practice Address - Street 1:404 NORTH ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2562
Practice Address - Country:US
Practice Address - Phone:814-337-6600
Practice Address - Fax:814-337-6607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy