Provider Demographics
NPI:1538236575
Name:ALAMO DISCOUNT PHARMACY INC
Entity type:Organization
Organization Name:ALAMO DISCOUNT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-568-7414
Mailing Address - Street 1:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:GA
Mailing Address - Zip Code:30411-0056
Mailing Address - Country:US
Mailing Address - Phone:912-568-7414
Mailing Address - Fax:912-568-1875
Practice Address - Street 1:7 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:GA
Practice Address - Zip Code:30411
Practice Address - Country:US
Practice Address - Phone:912-568-7414
Practice Address - Fax:912-568-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE003633332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000442131BMedicaid
GA0439870001Medicare NSC