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General NPI Number Information
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NPI Number | 1649212242
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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 | 06/11/2006
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Last Update Date | 01/25/2011
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Provider Practice Location Address
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Address Line | 549 MEDICAL DR
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City | CLARKSDALE
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State | MS
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Zip | 38614-6733
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Country | US
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Telephone | 662-624-2526
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Fax | 662-624-2527
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Provider Business Mailing Address
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Address Line | 549 MEDICAL DR
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City | CLARKSDALE
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State | MS
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Zip | 38614-6733
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Country | US
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Telephone | 662-624-2526
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Fax | 662-624-2527
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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 | 01807011
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License Number State | MS
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