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NPI Code Detail

MEDICARE: SHELBINA PHARMACY L L C

MEDICARE: SHELBINA PHARMACY L L C
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
13336C0003XCommunity/Retail Pharmacy2015016416MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12121570OTHERPK

General Provider Information

NPI Number : 1568694297
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHELBINA PHARMACY L L C
Provider Business Mailing Address
First Line : 201 N CENTER ST
Second Line : STE A
City : SHELBINA
State : MO
Zip : 63468-1117
Country : US
Telephone Number : 573-588-2143
Fax Number : 573-588-7545
Provider Business Practice Location Address
First Line : 201 N CENTER ST
Second Line : STE A
City : SHELBINA
State : MO
Zip : 63468-1117
Country : US
Telephone Number : 573-588-2143
Fax Number : 573-588-7545
Authorized Official
Title or Position : OWNER/PIC
Name : JONATHAN PATRICK EARLEY
Credential :
Telephone Number : 573-588-2143
Provider Enumeration Date : 08/13/2009
Last Update Date : 08/14/2019

Similar Medicare Providers

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Practice Location Address:
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1174542682 — HANNIBAL REGIONAL HEALTHCARE SYSTEM, INC
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Directions to “SHELBINA PHARMACY L L C ” Practice Location

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