MEDICARE: NEW MARKET HEALTHCARE LLC

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	112550	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2142431	OTHER		PK

General Provider Information

NPI Number	:	1659707891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MARKET HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 709
Second Line	:
City	:	ATHENS
State	:	AL
Zip	:	35612-0709
Country	:	US
Telephone Number	:	256-232-3811
Fax Number	:	256-232-2422

Provider Business Practice Location Address
First Line	:	5324 WINCHESTER RD
Second Line	:
City	:	NEW MARKET
State	:	AL
Zip	:	35761-7430
Country	:	US
Telephone Number	:	256-379-4670
Fax Number	:	256-379-4680

Authorized Official
Title or Position	:	CO OWNER
Name	:	CHANDLER WILLINGHAM
Credential	:
Telephone Number	:	256-232-3811

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	02/21/2017

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