MEDICARE: SHELTON PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	OH
3	335E00000X	Prosthetic/Orthotic Supplier	OH
4	332B00000X	Durable Medical Equipment & Medical Supplies	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3604041	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265544274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELTON PHARMACY

Provider Business Mailing Address
First Line	:	1525 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1707
Country	:	US
Telephone Number	:	937-253-4108
Fax Number	:	937-253-8662

Provider Business Practice Location Address
First Line	:	1525 WAYNE AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1707
Country	:	US
Telephone Number	:	937-253-4108
Fax Number	:	937-253-8662

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN SHELTON
Credential	:
Telephone Number	:	937-253-4108

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/12/2007

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Directions to “SHELTON PHARMACY ” Practice Location

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