1174548705 NPI number — SMITHS FOOD & DRUG CENTERS INC

Table of Contents

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: 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".