MEDICARE: PHARMACY PLUS, 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	16892	TX
2	3336C0004X	Compounding Pharmacy	16892	TX
3	3336C0003X	Community/Retail Pharmacy	16892	TX

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	4579249	OTHER	TX	NCPDP #

General Provider Information

NPI Number	:	1588696835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHARMACY PLUS, INC.

Provider Business Mailing Address
First Line	:	2901 CORPORATE CIR
Second Line	:	STE 100
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-5625
Country	:	US
Telephone Number	:	254-739-2526
Fax Number	:	254-739-2528

Provider Business Practice Location Address
First Line	:	635 N ROBINSON DR
Second Line	:	SUITE 16
City	:	ROBINSON
State	:	TX
Zip	:	76706-5330
Country	:	US
Telephone Number	:	254-662-4444
Fax Number	:	254-662-0805

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS MANNING NEALE SR.
Credential	:	RPH
Telephone Number	:	469-635-2849

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	08/05/2011

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Directions to “PHARMACY PLUS, INC. ” Practice Location

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