MEDICARE: BEST BUY PHARMACY OF SHELBINA 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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	006633	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2609937	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	2609937	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1881708857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEST BUY PHARMACY OF SHELBINA INC

Provider Business Mailing Address
First Line	:	201 N CENTER ST
Second Line	:
City	:	SHELBINA
State	:	MO
Zip	:	63468-1117
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N CENTER ST
Second Line	:
City	:	SHELBINA
State	:	MO
Zip	:	63468-1117
Country	:	US
Telephone Number	:	573-588-2143
Fax Number	:	573-588-7545

Authorized Official
Title or Position	:	MGR
Name	:	GENA HATCHER
Credential	:
Telephone Number	:	573-588-2143

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/12/2007

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