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General NPI Number Information
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NPI Number | 1831194588
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Entity Type | Organization
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Legal Business Name | MED-SHOPPE PHARMACY INC
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Dates
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Enumeration Date | 06/18/2005
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Last Update Date | 10/08/2021
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Provider Practice Location Address
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Address Line | 2900 16TH ST
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City | BEDFORD
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State | IN
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Zip | 47421-3510
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Country | US
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Telephone | 812-275-1340
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Fax | 812-275-1450
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Provider Business Mailing Address
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Address Line | PO BOX 966
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City | BEDFORD
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State | IN
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Zip | 47421-0966
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Country | US
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Telephone | 812-275-5949
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Fax | 812-277-3632
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN MARK ANDERSON
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Credential |
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Telephone | 812-329-6466
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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 | 60005776
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License Number State | IN
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