Healthcare Provider Details

I. General information

NPI: 1255982567
Provider Name (Legal Business Name): ORACLE PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S PENDLETON ST STE C
EASLEY SC
29642-1047
US

IV. Provider business mailing address

157 ARMISTEAD LN
EASLEY SC
29642-8636
US

V. Phone/Fax

Practice location:
  • Phone: 256-503-5535
  • Fax:
Mailing address:
  • Phone: 256-503-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. JERRY ANTHONY SHELBY III
Title or Position: OWNER
Credential: PHARMD
Phone: 256-503-5535