Provider Demographics
NPI:1508907759
Name:S & B DISCOUNT DRUGS OF COLUMBUS, INC
Entity Type:Organization
Organization Name:S & B DISCOUNT DRUGS OF COLUMBUS, INC
Other - Org Name:SHELTON'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-327-1614
Mailing Address - Street 1:115 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5220
Mailing Address - Country:US
Mailing Address - Phone:662-327-1614
Mailing Address - Fax:662-328-1909
Practice Address - Street 1:115 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5220
Practice Address - Country:US
Practice Address - Phone:662-327-1614
Practice Address - Fax:662-328-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01613333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2500646OtherNCPDP NUMBER
MS00092266Medicaid