MEDICARE: SHELBY DRUGS 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1538906532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBY DRUGS LLC

Provider Business Mailing Address
First Line	:	25302 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2102
Country	:	US
Telephone Number	:	313-406-6333
Fax Number	:	313-406-6338

Provider Business Practice Location Address
First Line	:	25302 W WARREN ST
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48127-2102
Country	:	US
Telephone Number	:	313-406-6333
Fax Number	:	313-406-6338

Authorized Official
Title or Position	:	CEO
Name	:	DR. MAISA HIDER
Credential	:	MD
Telephone Number	:	313-406-6333

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	02/03/2026

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Directions to “SHELBY DRUGS LLC ” Practice Location

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