MEDICARE: MCCONAGHY DRUG STORE, INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	106354	AL
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	332BX2000X	Oxygen Equipment & Supplies (DME)	106354	AL
4	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457429144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCONAGHY DRUG STORE, INC

Provider Business Mailing Address
First Line	:	PO BOX 247
Second Line	:
City	:	MC INTOSH
State	:	AL
Zip	:	36553-0247
Country	:	US
Telephone Number	:	251-944-8227
Fax Number	:	251-944-8226

Provider Business Practice Location Address
First Line	:	61 RIVER RD
Second Line	:
City	:	MCINTOSH
State	:	AL
Zip	:	36553
Country	:	US
Telephone Number	:	251-944-8227
Fax Number	:	251-944-8226

Authorized Official
Title or Position	:	DME DIRECTOR
Name	:	MR. RANDY WARD DAVIDSON
Credential	:
Telephone Number	:	251-944-8227

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	11/24/2021

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Directions to “MCCONAGHY DRUG STORE, INC ” Practice Location

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