Provider Demographics
NPI:1932845195
Name:APOLLO PHARMACY OF SHELBY, INC
Entity Type:Organization
Organization Name:APOLLO PHARMACY OF SHELBY, INC
Other - Org Name:APOLLO PHARMACY OF SHELBY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEHALKUMAR
Authorized Official - Middle Name:RANJIT
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-960-5511
Mailing Address - Street 1:46591 ROMEO PLANK RD STE 125
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-5743
Mailing Address - Country:US
Mailing Address - Phone:586-960-5511
Mailing Address - Fax:586-325-2939
Practice Address - Street 1:46591 ROMEO PLANK RD STE 125
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48044-5743
Practice Address - Country:US
Practice Address - Phone:586-960-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932845195Medicaid