MEDICARE: ALAMO DISCOUNT PHARMACY 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	PHRE003633	GA

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

General Provider Information

NPI Number	:	1538236575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMO DISCOUNT PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 56
Second Line	:
City	:	ALAMO
State	:	GA
Zip	:	30411-0056
Country	:	US
Telephone Number	:	912-568-7414
Fax Number	:	912-568-1875

Provider Business Practice Location Address
First Line	:	7 WEST MAIN STREET
Second Line	:
City	:	ALAMO
State	:	GA
Zip	:	30411
Country	:	US
Telephone Number	:	912-568-7414
Fax Number	:	912-568-1875

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MITCHELL S HERRINGTON
Credential	:
Telephone Number	:	912-568-7414

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	03/26/2012

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