MEDICARE: ALEXANDER PHARMACY LP

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	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy	24686	TX

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
2	2095773	OTHER		PK

General Provider Information

NPI Number	:	1619067691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDER PHARMACY LP

Provider Business Mailing Address
First Line	:	PO BOX 1303
Second Line	:
City	:	EAST BERNARD
State	:	TX
Zip	:	77435-1303
Country	:	US
Telephone Number	:	979-335-4810
Fax Number	:	979-335-4185

Provider Business Practice Location Address
First Line	:	123 LEVERIDGE
Second Line	:
City	:	EAST BERNARD
State	:	TX
Zip	:	77435
Country	:	US
Telephone Number	:	979-335-4810
Fax Number	:	979-335-4185

Authorized Official
Title or Position	:	OWNER,PIC,AO
Name	:	HENRY ALEXANDER
Credential	:	RPH
Telephone Number	:	979-335-4810

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	05/22/2015

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Directions to “ALEXANDER PHARMACY LP ” Practice Location

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