Provider Demographics
NPI:1336236520
Name:M & M PHARMACY INC
Entity Type:Organization
Organization Name:M & M PHARMACY INC
Other - Org Name:ARUNDEL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTUPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-761-3443
Mailing Address - Street 1:7571 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3716
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7571 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3716
Practice Address - Country:US
Practice Address - Phone:410-761-3443
Practice Address - Fax:410-590-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP00021333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2105054OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MD403286100Medicaid
MD403286100Medicaid