1083595458 NPI number — SMART CHOICE COMPOUNDING PHARMACY

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 1083595458 NPI number — SMART CHOICE COMPOUNDING PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMART CHOICE COMPOUNDING PHARMACY
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:
1083595458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4090 MAPLESHADE LN STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-0045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-941-9601
Provider Business Mailing Address Fax Number:
469-941-9565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4090 MAPLESHADE LANE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TEXAS
Provider Business Practice Location Address Postal Code:
75093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/10/2025

Additional Information

Authorized Official

Authorized Official Last Name:
JADEJA
Authorized Official First Name:
AJAYKUMAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACIST
Authorized Official Telephone Number:
972-896-9407

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; 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)





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