Provider Demographics
NPI:1790052157
Name:SHELLNUTS ACES INC
Entity Type:Organization
Organization Name:SHELLNUTS ACES INC
Other - Org Name:R & M FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-261-6332
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-0375
Mailing Address - Country:US
Mailing Address - Phone:931-403-2552
Mailing Address - Fax:931-403-2556
Practice Address - Street 1:1970 BRADFORD HICKS DR STE B
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-2247
Practice Address - Country:US
Practice Address - Phone:931-403-2552
Practice Address - Fax:931-403-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X
TN49493336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132695OtherPK
TN1530527Medicaid
6707070001Medicare NSC