MEDICARE: CONCEPT PHARMACEUTICALS LLC

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	3336M0002X	Mail Order Pharmacy
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy	112714	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0133417	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1124060793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCEPT PHARMACEUTICALS LLC

Provider Business Mailing Address
First Line	:	1460 ANN ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-3103
Country	:	US
Telephone Number	:	800-784-0149
Fax Number	:	800-856-7820

Provider Business Practice Location Address
First Line	:	1460 ANN ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-3103
Country	:	US
Telephone Number	:	334-386-1261
Fax Number	:	800-856-7820

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	GREG MCNIDER
Credential	:	PHARM.D.
Telephone Number	:	800-784-0149

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	01/29/2010

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