MEDICARE: ALLIANCE PHARMACY PLUS 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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy

General Provider Information

NPI Number	:	1871246413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE PHARMACY PLUS LLC

Provider Business Mailing Address
First Line	:	3400 ANNAPOLIS RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-1120
Country	:	US
Telephone Number	:	443-869-2512
Fax Number	:	443-869-2709

Provider Business Practice Location Address
First Line	:	3400 ANNAPOLIS RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21227-1120
Country	:	US
Telephone Number	:	443-869-2512
Fax Number	:	443-869-2709

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MR. EMEKA KENNETH MUNONYE
Credential	:	RPH
Telephone Number	:	310-489-9982

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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