MEDICARE: ALPHA PHARMACY, 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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0004X	Compounding Pharmacy
4	3336H0001X	Home Infusion Therapy Pharmacy
5	3336L0003X	Long Term Care Pharmacy
6	3336M0003X	Managed Care Organization Pharmacy
7	3336C0003X	Community/Retail Pharmacy	26930	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5900560	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1962715409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA PHARMACY, LLC

Provider Business Mailing Address
First Line	:	2709 PEBBLE CREEK DR
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77581-4483
Country	:	US
Telephone Number	:	832-725-7256
Fax Number	:

Provider Business Practice Location Address
First Line	:	11002 SCARSDALE BLVD STE C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77089-5973
Country	:	US
Telephone Number	:	281-481-3366
Fax Number	:	281-220-6441

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	LOI VU
Credential	:
Telephone Number	:	832-725-7256

Provider Enumeration Date	:	07/26/2010
Last Update Date	:	07/26/2010

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Directions to “ALPHA PHARMACY, LLC ” Practice Location

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