Provider Demographics
NPI:1265087753
Name:MZM PHARMACY LLC
Entity type:Organization
Organization Name:MZM PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANAL
Authorized Official - Middle Name:MOTAWADEE ZAREKH
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-206-8301
Mailing Address - Street 1:136 STATION TER E
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25403-4004
Mailing Address - Country:US
Mailing Address - Phone:703-206-8301
Mailing Address - Fax:304-350-8426
Practice Address - Street 1:33 MEADOW LN UNIT 7
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-3807
Practice Address - Country:US
Practice Address - Phone:681-247-2385
Practice Address - Fax:304-350-8426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy