Provider Demographics
NPI:1528273737
Name:MCCONAGHY DRUG STORE INC
Entity type:Organization
Organization Name:MCCONAGHY DRUG STORE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCCONAGHY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-846-6290
Mailing Address - Street 1:P.O.BOX 199
Mailing Address - Street 2:30282 HWY 17
Mailing Address - City:MILLRY
Mailing Address - State:AL
Mailing Address - Zip Code:36558
Mailing Address - Country:US
Mailing Address - Phone:251-846-6290
Mailing Address - Fax:251-846-6208
Practice Address - Street 1:30282 HWY 17
Practice Address - Street 2:
Practice Address - City:MILLRY
Practice Address - State:AL
Practice Address - Zip Code:36558
Practice Address - Country:US
Practice Address - Phone:251-846-6290
Practice Address - Fax:251-846-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111191332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002969Medicaid
AL0127983OtherNCPDP
AL0324320005Medicare NSC