Provider Demographics
NPI:1952391146
Name:M & M DRUG INC
Entity Type:Organization
Organization Name:M & M DRUG INC
Other - Org Name:M & M DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-623-1980
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40476-1088
Mailing Address - Country:US
Mailing Address - Phone:859-623-1980
Mailing Address - Fax:606-625-1899
Practice Address - Street 1:110 BIG HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2008
Practice Address - Country:US
Practice Address - Phone:859-623-1980
Practice Address - Fax:606-625-1899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KYPO61163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1808180OtherNCPDP PROVIDER IDENTIFICATION NUMBER
KY54033071Medicaid
KY90200767Medicaid
KY54033071Medicaid