# SHELBY DRUG CO INC HWY 61 SOUTH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HAIRE DRUG CENTER
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649212242
- **Authorized official:** EDDIE ELLIS RPH (OWNER)
- **Authorized official phone:** (662) 624-2526

## Contact information

- **Practice address:** 549 MEDICAL DR, CLARKSDALE, MS 38614-6733
- **Practice address phone:** (662) 624-2526
- **Practice address fax:** (662) 624-2527
- **Mailing address:** 549 MEDICAL DR, CLARKSDALE, MS 38614-6733
- **Mailing address phone:** (662) 624-2526
- **Mailing address fax:** (662) 624-2527

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 01807011 | MS | Yes |

## Other

- **Enumeration date:** 06/11/2006
- **Last updated:** 01/25/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2513934 | NCPDP PROVIDER IDENTIFICATION NUMBER | — |