MEDICARE: DUNAWAY DRUG STORES, 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	333600000X	Pharmacy	846	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000069757	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619950615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNAWAY DRUG STORES, INC.

Provider Business Mailing Address
First Line	:	110 3RD ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2993
Country	:	US
Telephone Number	:	270-826-6565
Fax Number	:	270-830-0083

Provider Business Practice Location Address
First Line	:	110 3RD ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2993
Country	:	US
Telephone Number	:	270-826-6565
Fax Number	:	270-830-0083

Authorized Official
Title or Position	:	PRESIDENT PHARMACIST
Name	:	MR. JAMES DUNAWAY
Credential	:	R.PH.
Telephone Number	:	270-826-6565

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	03/31/2008

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Directions to “DUNAWAY DRUG STORES, INC. ” Practice Location

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