Provider Demographics
NPI:1891727111
Name:DMTT LLC
Entity Type:Organization
Organization Name:DMTT LLC
Other - Org Name:H&M DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-447-3746
Mailing Address - Street 1:1772 CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5225
Mailing Address - Country:US
Mailing Address - Phone:985-447-3746
Mailing Address - Fax:985-449-7521
Practice Address - Street 1:17216 HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:WEDOWEE
Practice Address - State:AL
Practice Address - Zip Code:36278-4574
Practice Address - Country:US
Practice Address - Phone:256-357-4614
Practice Address - Fax:256-357-4641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336H0001X
AL1048503336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000227983CMedicaid
AL161511Medicaid
AL168025Medicaid
2147084OtherPK
GA000227983CMedicaid