1114067956 NPI number — SMITH DRUG CO

Table of content: (NPI 1114067956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114067956 NPI number — SMITH DRUG CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITH DRUG CO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
K MOSIER INC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114067956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 N TENNESSEE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-542-4431
Provider Business Mailing Address Fax Number:
972-542-4303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 N TENNESSEE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-542-4431
Provider Business Practice Location Address Fax Number:
972-542-4303
Provider Enumeration Date:
02/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELLIOTT
Authorized Official First Name:
JIM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PIC
Authorized Official Telephone Number:
972-542-4431

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  22038 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 145228 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1485228 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4524129 . This is a "NABP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".