Organization
SHELBY DRUG CO INC HWY 61 SOUTH
Active
Other names
SHELBY DRUG COMPANY
Organization subpart
No
Provider details
NPI number
Authorized official
EDDIE ELLIS RPH (OWNER)
(662) 624-2526
Entity
Organization
Contact information
Practice address
1211 BROADWAY HWY 61 SO, SHELBY, MS 38774
(662) 398-7487
(662) 398-7109
Mailing address
1211 BROADWAY HWY 61 SO, PO BOX 1105, SHELBY, MS 38774
(662) 398-7487
(662) 398-7109
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
00798/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2507119
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/23/2007
Last updated
12/17/2012
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