Healthcare Provider Details

I. General information

NPI: 1992279855
Provider Name (Legal Business Name): SHELLMAN PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WEST RAILROAD ST.
SHELLMAN GA
39886
US

IV. Provider business mailing address

PO BOX 59
SHELLMAN GA
39886
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPHRE010689
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerGEORGIA STATE RETAIL PHARMACY PERMIT

VIII. Authorized Official

Name: JESSICA JONES
Title or Position: OWNER/PHARMACIST
Credential: PHARMD
Phone: 229-679-5070