Provider Demographics
NPI:1679676126
Name:M AND M DRUG COMPANY, INC
Entity type:Organization
Organization Name:M AND M DRUG COMPANY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALTON
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-783-2040
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-0056
Mailing Address - Country:US
Mailing Address - Phone:478-783-2040
Mailing Address - Fax:478-783-2041
Practice Address - Street 1:416 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036
Practice Address - Country:US
Practice Address - Phone:478-783-2040
Practice Address - Fax:478-783-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0092413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00031127AMedicaid
GA00031127AMedicaid