Provider Demographics
NPI:1033368899
Name:DONALD WAYNE SMITH
Entity Type:Organization
Organization Name:DONALD WAYNE SMITH
Other - Org Name:FORTY NINE DRUG COMPANY #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PIC
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:209-956-4949
Mailing Address - Street 1:937 N YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95203-2216
Mailing Address - Country:US
Mailing Address - Phone:209-465-2671
Mailing Address - Fax:209-465-6831
Practice Address - Street 1:104 LINCOLN CTR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-2607
Practice Address - Country:US
Practice Address - Phone:209-956-4949
Practice Address - Fax:209-465-6831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY491483336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy