Provider Demographics
NPI:1407046287
Name:SHIELDS PHARMACY, INC.
Entity Type:Organization
Organization Name:SHIELDS PHARMACY, INC.
Other - Org Name:SHIELDS PHARMACY-STRAFFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:COUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:417-736-9781
Mailing Address - Street 1:100 S CRITTENDEN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-2121
Mailing Address - Country:US
Mailing Address - Phone:417-468-2046
Mailing Address - Fax:417-468-2482
Practice Address - Street 1:423 E OLD ROUTE 66
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:MO
Practice Address - Zip Code:65757-7817
Practice Address - Country:US
Practice Address - Phone:417-736-9781
Practice Address - Fax:417-736-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007022190332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2637493OtherNCPDP