1174548705 NPI number — SMITHS FOOD & DRUG CENTERS INC

Table of content: (NPI 1174548705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174548705 NPI number — SMITHS FOOD & DRUG CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITHS FOOD & DRUG CENTERS INC
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:
SMITHS PHARMACY #499
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:
1174548705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30550
Provider Second Line Business Mailing Address:
MS 44010 010C
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84130-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-974-1402
Provider Business Mailing Address Fax Number:
801-973-1704

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 N CALIFORNIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOCORRO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87801-4269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-835-9495
Provider Business Practice Location Address Fax Number:
575-838-4916
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LANGWORTHY
Authorized Official First Name:
KARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER OF PHARMACY CREDENTIALING
Authorized Official Telephone Number:
513-698-1878

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH00002367 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0365690290 . This identifiers is of the category "MEDICARE NSC".
  • Identifier: 800521150 . This identifiers is of the category "MEDICARE PIN".
  • Identifier: 2058726 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000K2066 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870021772 . This identifiers is of the category "MEDICARE PIN".