NPIMap

Organization Active NPI

Shelby Drug Co Inc Hwy 61 South

Doing business as Haire Drug Center

  • Community/Retail Pharmacy
  • Clarksdale, MS
National Provider Identifier
1649212242
Registry record updated Jan 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
01807011 Issued in MS
Legal business name
SHELBY DRUG CO INC HWY 61 SOUTH
Doing business as
Haire Drug Center
Practice address
549 Medical Dr
Clarksdale, MS 38614-6733
Phone
(662) 624-2526
Fax
(662) 624-2527
NPI assigned
Jun 11, 2006
Last updated
Jan 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Eddie Ellis, RPH
Title
Owner
Phone
(662) 624-2526

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 01807011 MS Primary

Addresses

Primary practice location

549 Medical Dr
Clarksdale, MS 38614-6733

Mailing address

549 Medical Dr
Clarksdale, MS 38614-6733
Phone (662) 624-2526

Other identifiers 1

IdentifierTypeStateIssuer
2513934OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • HAIRE DRUG CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Haire Drug Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

549 Medical Dr
Clarksdale, MS 38614
Phone (662) 624-2526

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295913600000",
    "number": "1649212242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 MEDICAL DR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146733",
            "telephone_number": "662-624-2526",
            "fax_number": "662-624-2527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 MEDICAL DR",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146733",
            "telephone_number": "662-624-2526",
            "fax_number": "662-624-2527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELBY DRUG CO INC HWY 61 SOUTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2011-01-25",
        "status": "A",
        "authorized_official_last_name": "ELLIS",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-624-2526",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "01807011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2513934",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAIRE DRUG CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.