MEDICARE: DRAGGON DRUG 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	333600000X	Pharmacy	PH00001162	NM
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3202823	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295847200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRAGGON DRUG INC

Provider Business Mailing Address
First Line	:	PO BOX 1243
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-1243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1377 DIAMOND DR
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2218
Country	:	US
Telephone Number	:	505-662-6189
Fax Number	:	505-662-3171

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GEORGE ANDERSON
Credential	:
Telephone Number	:	505-662-6189

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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