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General NPI Number Information
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NPI Number | 1457429144
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Entity Type | Organization
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Legal Business Name | MCCONAGHY DRUG STORE, INC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 61 RIVER RD
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City | MCINTOSH
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State | AL
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Zip | 36553
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Country | US
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Telephone | 251-944-8227
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Fax | 251-944-8226
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | MC INTOSH
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State | AL
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Zip | 36553-0247
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Country | US
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Telephone | 251-944-8227
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Fax | 251-944-8226
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Authorized Official
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Title or Position | DME DIRECTOR
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Name | MR. RANDY WARD DAVIDSON
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Credential |
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Telephone | 251-944-8227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 106354
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 106354
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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