MEDICARE: 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	15275	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4587866	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1427180454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRUG STORE INC

Provider Business Mailing Address
First Line	:	PO BOX 1985
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75802-1985
Country	:	US
Telephone Number	:	903-731-4734
Fax Number	:	903-731-4305

Provider Business Practice Location Address
First Line	:	2305 W OAK ST
Second Line	:
City	:	PALESTINE
State	:	TX
Zip	:	75801-4063
Country	:	US
Telephone Number	:	903-731-4734
Fax Number	:	903-731-4305

Authorized Official
Title or Position	:	PRESIDENT / PIC
Name	:	GREGORY SCALAPINO
Credential	:	PHRMD
Telephone Number	:	903-731-4734

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	02/19/2010

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Directions to “DRUG STORE INC ” Practice Location

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