1184053571 NPI number — SMITH DRUG AND COMPOUNDING INC

Table of content: (NPI 1184053571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184053571 NPI number — SMITH DRUG AND COMPOUNDING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITH DRUG AND COMPOUNDING 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:
SMITH DRUG AND COMPOUNDING, 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:
1184053571
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1629 AIRPORT RD STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71913-8069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-767-2220
Provider Business Mailing Address Fax Number:
501-463-4261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1629 AIRPORT RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71913-8069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-767-2220
Provider Business Practice Location Address Fax Number:
501-463-4261
Provider Enumeration Date:
11/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
LANCE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
501-767-2220

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: AR20732 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 200267407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2142796 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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