1932193091 NPI number — SMITHLAND DRUGS, INC.

Table of content: (NPI 1932193091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932193091 NPI number — SMITHLAND DRUGS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITHLAND DRUGS, 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:
Provider Other Organization Name Type Code:
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:
1932193091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42081-0010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-928-2161
Provider Business Mailing Address Fax Number:
270-928-2293

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 EAST ADAIR ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42081-0010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-928-2161
Provider Business Practice Location Address Fax Number:
270-928-2293
Provider Enumeration Date:
09/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOODYARD
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SEC/TREAS
Authorized Official Telephone Number:
270-928-4272

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PO6746 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1812761 . This is a "NABP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 54003488 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 90004995 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".