Provider Demographics
NPI:1487706925
Name:MAM ENTERPRISES INC
Entity type:Organization
Organization Name:MAM ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MCMURRY
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:501-261-7181
Mailing Address - Street 1:PO BOX 241250
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0005
Mailing Address - Country:US
Mailing Address - Phone:501-261-7181
Mailing Address - Fax:501-261-7307
Practice Address - Street 1:11200 ARCH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72206-4649
Practice Address - Country:US
Practice Address - Phone:501-261-7181
Practice Address - Fax:501-261-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR202753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142625407Medicaid
5G678OtherMEDICARE MASS IMMUNIZATION PTAN