Provider Demographics
NPI:1750446365
Name:PHARMACISTS ASSOC OF SHELBY CO INC
Entity Type:Organization
Organization Name:PHARMACISTS ASSOC OF SHELBY CO INC
Other - Org Name:MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALBRIGHT
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-774-3996
Mailing Address - Street 1:207 S PINE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-1749
Mailing Address - Country:US
Mailing Address - Phone:217-774-3996
Mailing Address - Fax:217-774-2773
Practice Address - Street 1:207 S PINE
Practice Address - Street 2:SUITE 10
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1749
Practice Address - Country:US
Practice Address - Phone:217-774-3996
Practice Address - Fax:217-774-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid