Healthcare Provider Details

I. General information

NPI: 1881708857
Provider Name (Legal Business Name): BEST BUY PHARMACY OF SHELBINA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CENTER ST
SHELBINA MO
63468-1117
US

IV. Provider business mailing address

201 N CENTER ST
SHELBINA MO
63468-1117
US

V. Phone/Fax

Practice location:
  • Phone: 573-588-2143
  • Fax: 573-588-7545
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 Number006633
License Number StateMO

VIII. Authorized Official

Name: GENA HATCHER
Title or Position: MGR
Credential:
Phone: 573-588-2143