Healthcare Provider Details

I. General information

NPI: 1881788297
Provider Name (Legal Business Name): SHIELD PHCY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S CRITTENDEN ST
MARSHFIELD MO
65706-2121
US

IV. Provider business mailing address

100 S CRITTENDEN ST
MARSHFIELD MO
65706-2121
US

V. Phone/Fax

Practice location:
  • Phone: 417-468-2046
  • Fax: 417-468-2482
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number000601
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JERRY COUNTS
Title or Position: OWNER
Credential: RPH
Phone: 417-468-2046