Provider Demographics
NPI:1821195546
Name:MODERN MEDICATION MANAGEMENT, INC
Entity Type:Organization
Organization Name:MODERN MEDICATION MANAGEMENT, INC
Other - Org Name:BEAVER FALLS CORNER DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM TECH.
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:M
Authorized Official - Last Name:EVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-891-0600
Mailing Address - Street 1:1500 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4164
Mailing Address - Country:US
Mailing Address - Phone:724-891-0600
Mailing Address - Fax:724-891-8233
Practice Address - Street 1:1500 7TH AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-4164
Practice Address - Country:US
Practice Address - Phone:724-891-0600
Practice Address - Fax:724-891-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP-415380-L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016761250001Medicaid
3974020OtherNCPDP
3974020OtherNCPDP