MEDICARE: AA PHARMACY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	33278	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33278	OTHER	TX	TEXAS STATE BOARD OF PHARMACY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386034338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AA PHARMACY LLC

Provider Business Mailing Address
First Line	:	17826 DAVENPORT RD STE B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5876
Country	:	US
Telephone Number	:	469-351-3462
Fax Number	:	469-565-2220

Provider Business Practice Location Address
First Line	:	17826 DAVENPORT RD STE B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75252-5876
Country	:	US
Telephone Number	:	469-351-3462
Fax Number	:	469-565-2220

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	MR. AMOS MOMANYI ABUGA
Credential	:	RPH
Telephone Number	:	214-476-6289

Provider Enumeration Date	:	01/29/2015
Last Update Date	:	08/31/2016

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