MEDICARE: MISS MEGHAN ALEXA DOLLY PHARMD

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	183500000X	Pharmacist	37844	SC
2	1835P2201X	Ambulatory Care Pharmacist	37844	SC
3	1835P1200X	Pharmacotherapy Pharmacist	37844	SC

General Provider Information

NPI Number	:	1124506035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MEGHAN ALEXA DOLLY PHARMD

Provider Business Mailing Address
First Line	:	3601 SOUTH 6TH AVENUE
Second Line	:	1-119 PHARMACY SERVICE
City	:	TUCSON
State	:	AZ
Zip	:	85723
Country	:	US
Telephone Number	:	205-792-1450
Fax Number	:	520-838-3617

Provider Business Practice Location Address
First Line	:	3601 S 6TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85723-3620
Country	:	US
Telephone Number	:	205-792-1450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	12/19/2022

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