MEDICARE: MACON CITY DRUG STORE, 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336L0003X	Long Term Care Pharmacy
4	3336C0003X	Community/Retail Pharmacy	00125011	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2043292	OTHER	PK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346273588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACON CITY DRUG STORE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 424
Second Line	:
City	:	MACON
State	:	MS
Zip	:	39341-0424
Country	:	US
Telephone Number	:	662-726-5143
Fax Number	:	662-726-5183

Provider Business Practice Location Address
First Line	:	3281 JEFFERSON ST
Second Line	:
City	:	MACON
State	:	MS
Zip	:	39341-2279
Country	:	US
Telephone Number	:	662-726-5143
Fax Number	:	662-726-5183

Authorized Official
Title or Position	:	MANAGER
Name	:	MEGAN F JOHNSON
Credential	:
Telephone Number	:	662-726-5143

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	01/26/2024

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Directions to “MACON CITY DRUG STORE, INC. ” Practice Location

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