Provider Demographics
NPI:1023312477
Name:M & M PHARMACY CORP
Entity type:Organization
Organization Name:M & M PHARMACY CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAHONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-854-3535
Mailing Address - Street 1:6419 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:201-854-3535
Mailing Address - Fax:201-854-6770
Practice Address - Street 1:6419 PARK AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-854-3535
Practice Address - Fax:201-854-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS05547003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3197577OtherNCPDP PROVIDER IDENTIFICATION NUMBER
NJ6527480001Medicare NSC