Provider Demographics
NPI:1043230485
Name:EJJE, INC
Entity Type:Organization
Organization Name:EJJE, INC
Other - Org Name:SHELTON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-692-1022
Mailing Address - Street 1:2315 ASHEVILLE HWY
Mailing Address - Street 2:SUITE 50
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-1500
Mailing Address - Country:US
Mailing Address - Phone:828-692-1022
Mailing Address - Fax:828-698-1572
Practice Address - Street 1:2315 ASHEVILLE HWY
Practice Address - Street 2:SUITE 50
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-1500
Practice Address - Country:US
Practice Address - Phone:828-692-1022
Practice Address - Fax:828-698-1572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3419391OtherNCPDP
NC0455386Medicaid
NC0455386Medicaid