1265457899 NPI number — SMITHS FOOD & DRUG CENTERS INC

Table of content: (NPI 1265457899)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265457899 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 #459
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:
1265457899
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 842772
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-2772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-762-1019
Provider Business Mailing Address Fax Number:
513-762-1092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 WYOMING BLVD NE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87113-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-857-9783
Provider Business Practice Location Address Fax Number:
505-857-9835
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MUENNICH
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER OF PHARMACY LICENSING
Authorized Official Telephone Number:
513-762-1019

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PH00002242 , 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: 2058700 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0365690248 . This identifiers is of the category "MEDICARE NSC".
  • Identifier: 00062883 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870021772 . This identifiers is of the category "MEDICARE PIN".
  • Identifier: 800521150 . This identifiers is of the category "MEDICARE PIN".