Provider Demographics
NPI:1891861555
Name:SHIELDS DRUGS INC
Entity Type:Organization
Organization Name:SHIELDS DRUGS INC
Other - Org Name:SERVICE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:BSP RPH
Authorized Official - Phone:601-853-4611
Mailing Address - Street 1:680 HIGHWAY 51
Mailing Address - Street 2:STE G
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2103
Mailing Address - Country:US
Mailing Address - Phone:601-853-4611
Mailing Address - Fax:601-853-0521
Practice Address - Street 1:680 HIGHWAY 51
Practice Address - Street 2:STE G
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2103
Practice Address - Country:US
Practice Address - Phone:601-853-4611
Practice Address - Fax:601-853-0521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MS03009/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2045451OtherPK
MS00330163Medicaid