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General NPI Number Information
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NPI Number | 1548395825
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Entity Type | Organization
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Legal Business Name | SHELBY DRUG CO INC HWY 61 SOUTH
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 1211 BROADWAY HWY 61 SO
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City | SHELBY
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State | MS
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Zip | 38774
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Country | US
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Telephone | 662-398-7487
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Fax | 662-398-7109
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Provider Business Mailing Address
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Address Line | 1211 BROADWAY HWY 61 SO PO BOX 1105
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City | SHELBY
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State | MS
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Zip | 38774
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Country | US
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Telephone | 662-398-7487
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Fax | 662-398-7109
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Authorized Official
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Title or Position | OWNER
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Name | EDDIE ELLIS
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Credential | RPH
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Telephone | 662-624-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 00798/01.1
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License Number State | MS
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