Healthcare Provider Details

I. General information

NPI: 1134136047
Provider Name (Legal Business Name): SHELLMAN DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W RAILROAD ST
SHELLMAN GA
39886
US

IV. Provider business mailing address

PO BOX 420
SHELLMAN GA
39886-0420
US

V. Phone/Fax

Practice location:
  • Phone: 229-679-5070
  • Fax: 229-679-5059
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE008704
License Number StateGA

VIII. Authorized Official

Name: GEORGE LANGFORD
Title or Position: PRESIDENT AND PHARMACIST
Credential: RPH
Phone: 229-679-5070