MEDICARE: MMRX OF EASLEY 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
2	3336C0003X	Community/Retail Pharmacy	7176	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4203876	OTHER	NCPDP PROVIDER IDENTIFICATION NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861466807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMRX OF EASLEY INC

Provider Business Mailing Address
First Line	:	101 W MAIN ST
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-2038
Country	:	US
Telephone Number	:	864-859-4015
Fax Number	:	864-859-3396

Provider Business Practice Location Address
First Line	:	101 W MAIN ST
Second Line	:
City	:	EASLEY
State	:	SC
Zip	:	29640-2038
Country	:	US
Telephone Number	:	864-859-4015
Fax Number	:	864-859-3396

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL MUIR
Credential	:	RPH
Telephone Number	:	864-859-4015

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	08/30/2010

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