MEDICARE: HORACE DANNY ALEXANDER BS PHARMACY

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	183500000X	Pharmacist	0202206474	VA

General Provider Information

NPI Number	:	1942289368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HORACE DANNY ALEXANDER BS PHARMACY

Provider Business Mailing Address
First Line	:	100 BREWSTER BLVD
Second Line	:
City	:	CAMP LEJEUNE
State	:	NC
Zip	:	28547-2538
Country	:	US
Telephone Number	:	910-450-4159
Fax Number	:	910-450-4194

Provider Business Practice Location Address
First Line	:	1035 NIDER BLVD
Second Line	:	SUITE 100
City	:	NORFOLK
State	:	VA
Zip	:	23521-2701
Country	:	US
Telephone Number	:	757-314-7494
Fax Number	:	757-314-7453

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	01/03/2014

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