NPIMap

Organization Active NPI

Shellnuts Aces Inc

  • Community/Retail Pharmacy
  • Livingston, TN
National Provider Identifier
1790052157
Registry record updated Jun 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
4949 Issued in TN
Legal business name
SHELLNUTS ACES INC
Doing business as
R & M Family Pharmacy
Practice address
1970 Bradford Hicks Dr Ste B
Livingston, TN 38570-2247
Phone
(931) 403-2552
Fax
(931) 403-2556
NPI assigned
Nov 29, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2015

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

Authorized official

Name
Jonathan Melton
Title
Pharmacist
Phone
(931) 261-6332

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 4949 TN Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1970 Bradford Hicks Dr Ste B
Livingston, TN 38570-2247

Mailing address

PO Box 375
Livingston, TN 38570-0375
Phone (931) 403-2552

Other identifiers 2

IdentifierTypeStateIssuer
2132695OtherPK
1530527MedicaidTN

Other names 1

  • R & M Family Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121012000176 TN DME Supplier - Pharmacy 7719136431 Practice locations: Livingston, TN

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shellnuts Aces Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1322524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435190400000",
    "number": "1790052157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 375",
            "city": "LIVINGSTON",
            "state": "TN",
            "postal_code": "385700375",
            "telephone_number": "931-403-2552",
            "fax_number": "931-403-2556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1970 BRADFORD HICKS DR STE B",
            "city": "LIVINGSTON",
            "state": "TN",
            "postal_code": "385702247",
            "telephone_number": "931-403-2552",
            "fax_number": "931-403-2556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELLNUTS ACES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-29",
        "last_updated": "2015-06-25",
        "status": "A",
        "authorized_official_last_name": "MELTON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "931-261-6332"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "4949",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2132695",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530527",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "R & M Family Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Livingston, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.