1922498351 NPI number — SHELTON PHARMACY

Table of content: (NPI 1922498351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922498351 NPI number — SHELTON PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELTON PHARMACY
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:
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:
1922498351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 EAGLE RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ONEONTA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35121-6813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-305-5516
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37177 US HIGHWAY 231
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
ASHVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35953-7342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-305-5516
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHELTON
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
CHASE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
205-305-5516

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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