Organization
MFMM INC
Active
Other names
SOUTH SUBURBAN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MARCEL JEAN (OWNER)
(708) 798-4300
Entity
Organization
Contact information
Practice address
3330 W 177TH ST, STE 1E, HAZEL CREST, IL 60429-2184
(708) 798-4300
(708) 798-4447
Mailing address
3330 W 177TH ST, STE 1E, HAZEL CREST, IL 60429-2184
(708) 798-4300
(708) 798-4447
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054.015826
IL
3336I0012X
Institutional Pharmacy
—
—
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023181
PK
—
Enumeration date
08/05/2006
Last updated
07/12/2016
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