Provider Demographics
NPI:1588194922
Name:INTEGRATED MEDICATION MANAGEMENT LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICATION MANAGEMENT LLC
Other - Org Name:HOMEFREE PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-380-1828
Mailing Address - Street 1:136 GAITHER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1725
Mailing Address - Country:US
Mailing Address - Phone:856-380-1828
Mailing Address - Fax:
Practice Address - Street 1:136 GAITHER DR STE 120
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1725
Practice Address - Country:US
Practice Address - Phone:856-380-1828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FB7081499OtherDEA
FB0498938OtherDEA