Provider Demographics
NPI:1326527078
Name:SHELLNUTS ACES INC
Entity type:Organization
Organization Name:SHELLNUTS ACES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:CLINT
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:931-403-2552
Mailing Address - Street 1:1970 BRADFORD HICKS DR STE B
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570-2247
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:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49493336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy