MEDICARE: ALEXANDER DRUG INCORPORATED

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	41265RP	ID

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	:	1962578526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDER DRUG INCORPORATED

Provider Business Mailing Address
First Line	:	490 N 2ND E
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2729
Country	:	US
Telephone Number	:	208-587-3346
Fax Number	:	208-587-2052

Provider Business Practice Location Address
First Line	:	490 N 2ND E
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2729
Country	:	US
Telephone Number	:	208-587-3346
Fax Number	:	208-587-2052

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFF S JAUSORO
Credential	:	PHARMD
Telephone Number	:	208-587-3346

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	03/09/2016

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Directions to “ALEXANDER DRUG INCORPORATED ” Practice Location

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