MEDICARE: MR DISCOUNT DRUGS OF BUTLER

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	3336C0003X	Community/Retail Pharmacy	107036	AL
2	332B00000X	Durable Medical Equipment & Medical Supplies	107036	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	510-54581	OTHER	AL	BCBS-AL

General Provider Information

NPI Number	:	1205971504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MR DISCOUNT DRUGS OF BUTLER

Provider Business Mailing Address
First Line	:	604 E PUSHMATAHA ST
Second Line	:
City	:	BUTLER
State	:	AL
Zip	:	36904-2620
Country	:	US
Telephone Number	:	205-459-2990
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 E PUSHMATAHA ST
Second Line	:
City	:	BUTLER
State	:	AL
Zip	:	36904-2620
Country	:	US
Telephone Number	:	205-459-2990
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GREGORY KEITH MANLEY
Credential	:
Telephone Number	:	205-459-2990

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	09/11/2025

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