MEDICARE: MCCONAGHY 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	332BX2000X	Oxygen Equipment & Supplies (DME)	111191	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0127983	OTHER	AL	NCPDP

General Provider Information

NPI Number	:	1528273737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCONAGHY DRUG STORE INC

Provider Business Mailing Address
First Line	:	P.O.BOX 199
Second Line	:	30282 HWY 17
City	:	MILLRY
State	:	AL
Zip	:	36558
Country	:	US
Telephone Number	:	251-846-6290
Fax Number	:	251-846-6208

Provider Business Practice Location Address
First Line	:	30282 HWY 17
Second Line	:
City	:	MILLRY
State	:	AL
Zip	:	36558
Country	:	US
Telephone Number	:	251-846-6290
Fax Number	:	251-846-6208

Authorized Official
Title or Position	:	VP
Name	:	MR. DAN C MCCONAGHY
Credential	:	RPH
Telephone Number	:	251-846-6290

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	02/16/2011

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Directions to “MCCONAGHY DRUG STORE INC ” Practice Location

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