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Provider Information for 1578588109


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SMITHS FOOD & DRUG CENTERS INC

Other Names:  
Doing Business As: 
SMITHS PHARMACY # 142

Organization Subpart: NO

NPI: 1578588109
Last Updated: 2016-05-18
Certification Date:

Details

NameValue
NPI1578588109
Enumeration Date2006-07-13
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: ALLISON MUENNICH
Title: MANAGER OF PHARMACY LICENSING
Phone: 5137621019
Mailing Address PO BOX 842772
BOSTON, MA 02284-2772
United States

Phone: 513-762-1019 | Fax:513-762-1092
 
Primary Practice Address 951 W 1700 S
SYRACUSE, UT 84075-9127
United States

Phone: 801-773-5373 | Fax:801-773-0399
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)2100245PK
MEDICAIDUT=========357
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 333600000X - Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyUT3497081703