Provider Demographics
NPI:1568694297
Name:SHELBINA PHARMACY L L C
Entity Type:Organization
Organization Name:SHELBINA PHARMACY L L C
Other - Org Name:SHELBINA PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:EARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-588-2143
Mailing Address - Street 1:201 N CENTER ST
Mailing Address - Street 2:STE A
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-1117
Mailing Address - Country:US
Mailing Address - Phone:573-588-2143
Mailing Address - Fax:573-588-7545
Practice Address - Street 1:201 N CENTER ST
Practice Address - Street 2:STE A
Practice Address - City:SHELBINA
Practice Address - State:MO
Practice Address - Zip Code:63468-1117
Practice Address - Country:US
Practice Address - Phone:573-588-2143
Practice Address - Fax:573-588-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150164163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121570OtherPK