MEDICARE: MED-SHOPPE PHARMACY INC

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	60005776	IN

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
2	2024681	OTHER		PK

General Provider Information

NPI Number	:	1831194588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED-SHOPPE PHARMACY INC

Provider Business Mailing Address
First Line	:	PO BOX 966
Second Line	:
City	:	BEDFORD
State	:	IN
Zip	:	47421-0966
Country	:	US
Telephone Number	:	812-275-5949
Fax Number	:	812-277-3632

Provider Business Practice Location Address
First Line	:	2900 16TH ST
Second Line	:
City	:	BEDFORD
State	:	IN
Zip	:	47421-3510
Country	:	US
Telephone Number	:	812-275-1340
Fax Number	:	812-275-1450

Authorized Official
Title or Position	:	OWNER
Name	:	STEVEN MARK ANDERSON
Credential	:
Telephone Number	:	812-329-6466

Provider Enumeration Date	:	06/18/2005
Last Update Date	:	10/08/2021

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Directions to “MED-SHOPPE PHARMACY INC ” Practice Location

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