Provider Demographics
NPI:1881708857
Name:BEST BUY PHARMACY OF SHELBINA INC
Entity type:Organization
Organization Name:BEST BUY PHARMACY OF SHELBINA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:GENA
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-588-2143
Mailing Address - Street 1:201 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBINA
Mailing Address - State:MO
Mailing Address - Zip Code:63468-1117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 N CENTER ST
Practice Address - Street 2:
Practice Address - City:SHELBINA
Practice Address - State:MO
Practice Address - Zip Code:63468-1117
Practice Address - Country:US
Practice Address - Phone:573-588-2143
Practice Address - Fax:573-588-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MO0066333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2609937OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2609937OtherOTHER ID NUMBER
3903780001Medicare NSC