Organization
KEITH A SHELTON
Active
Other names
MEDICINE SHOPPE
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH A SHELTON RPH (OWNER)
(573) 686-7216
Entity
Organization
Contact information
Practice address
200 N 10TH ST, POPLAR BLUFF, MO 63901-4856
(573) 686-7216
(573) 686-7217
Mailing address
200 N 10TH ST, POPLAR BLUFF, MO 63901-4856
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
MO
333600000X
Pharmacy
004034
MO
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2619231
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
601708506
—
MO
05
—
621708502
—
MO
Enumeration date
10/03/2006
Last updated
03/07/2023
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