Provider Demographics
NPI:1053320853
Name:SMITHS PHARMACY INC
Entity Type:Organization
Organization Name:SMITHS PHARMACY INC
Other - Org Name:SMITHS PHARMACY AND HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-862-5655
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:GA
Mailing Address - Zip Code:31006-0546
Mailing Address - Country:US
Mailing Address - Phone:478-862-5655
Mailing Address - Fax:478-862-2811
Practice Address - Street 1:10 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:GA
Practice Address - Zip Code:31006-4505
Practice Address - Country:US
Practice Address - Phone:478-862-5655
Practice Address - Fax:478-862-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
GAPHRE0045453336C0003X
GA230101020751-206183700000X
GA004545333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care PharmacyGroup - Multi-Specialty
No183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00793295AMedicaid
2016222OtherPK
1212870001Medicare NSC
GA1212870001Medicare NSC
GA00793295BMedicaid