Organization
SHELBY PHARMACY LLC
Active
Other names
Easley HealthMart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY SHELBY RPH (OWNER,PIC, AO)
(256) 503-5535
Entity
Organization
Contact information
Practice address
401 HILLCREST DR, EASLEY, SC 29640-1221
(864) 642-4879
(864) 712-9279
Mailing address
157 ARMISTEAD LN, EASLEY, SC 29642-8636
(256) 503-5535
(864) 712-9279
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
16737
SC
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2162483
PK
—
05
—
716737
—
SC
Enumeration date
08/10/2016
Last updated
09/12/2016
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