Provider Demographics
NPI:1023037256
Name:SMK PHARMACY CORP
Entity Type:Organization
Organization Name:SMK PHARMACY CORP
Other - Org Name:SMK PHARMACY CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-404-6464
Mailing Address - Street 1:8702 ROCKAWAY BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1610
Mailing Address - Country:US
Mailing Address - Phone:718-474-1600
Mailing Address - Fax:718-474-3076
Practice Address - Street 1:8702 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1610
Practice Address - Country:US
Practice Address - Phone:718-474-1600
Practice Address - Fax:718-474-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0275553336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2721488Medicaid
2067438OtherPK