MEDICARE: A & C DISCOUNT 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	3336C0003X	Community/Retail Pharmacy	26959	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2125463	OTHER		PK

General Provider Information

NPI Number	:	1396056313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & C DISCOUNT PHARMACY LLC

Provider Business Mailing Address
First Line	:	2600 N STEMMONS FWY
Second Line	:	STE 164
City	:	DALLAS
State	:	TX
Zip	:	75207-2113
Country	:	US
Telephone Number	:	469-331-8290
Fax Number	:	469-331-8291

Provider Business Practice Location Address
First Line	:	2600 N STEMMONS FWY
Second Line	:	STE 164
City	:	DALLAS
State	:	TX
Zip	:	75207-2113
Country	:	US
Telephone Number	:	469-331-8290
Fax Number	:	469-331-8291

Authorized Official
Title or Position	:	CCO
Name	:	MATT ECKEL
Credential	:
Telephone Number	:	469-333-8660

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	07/28/2016

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