MEDICARE: MCMAHAN PHARMACY SERVICES, 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	3336L0003X	Long Term Care Pharmacy

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	:	1679134845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCMAHAN PHARMACY SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 389
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-0389
Country	:	US
Telephone Number	:	325-648-2484
Fax Number	:	855-899-4147

Provider Business Practice Location Address
First Line	:	1503 W FRONT ST
Second Line	:
City	:	GOLDTHWAITE
State	:	TX
Zip	:	76844-2056
Country	:	US
Telephone Number	:	325-648-2484
Fax Number	:	855-899-4147

Authorized Official
Title or Position	:	OWNER, PIC
Name	:	MICHAEL MCMAHAN
Credential	:	RPH
Telephone Number	:	325-648-2484

Provider Enumeration Date	:	06/27/2019
Last Update Date	:	06/27/2019

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