1407046287 NPI number — SHIELDS PHARMACY, INC.

Table of content: (NPI 1407046287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407046287 NPI number — SHIELDS PHARMACY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIELDS PHARMACY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407046287
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 S CRITTENDEN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARSHFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65706-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-468-2046
Provider Business Mailing Address Fax Number:
417-468-2482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 E OLD ROUTE 66
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STRAFFORD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65757-7817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-736-9781
Provider Business Practice Location Address Fax Number:
417-736-9783
Provider Enumeration Date:
07/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COUNTS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
CARTER
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
417-736-9781

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2007022190 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 2007022190 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2637493 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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