MEDICARE: MALLETTE DRUG COMPANY 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	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	106470	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0103779	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922177815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALLETTE DRUG COMPANY INC

Provider Business Mailing Address
First Line	:	PO BOX 327
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-1205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	837 S THREE NOTCH ST
Second Line	:
City	:	ANDALUSIA
State	:	AL
Zip	:	36420-5321
Country	:	US
Telephone Number	:	334-222-1141
Fax Number	:	334-222-8361

Authorized Official
Title or Position	:	OWNER/PRES
Name	:	BOBBY SCOTT
Credential	:	RPH
Telephone Number	:	334-222-1141

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/11/2009

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Directions to “MALLETTE DRUG COMPANY INC ” Practice Location

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