Provider Demographics
NPI:1114014313
Name:SMITH DRUG CO INC
Entity Type:Organization
Organization Name:SMITH DRUG CO INC
Other - Org Name:SMITH DRUG CO INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STURGILL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-354-5622
Mailing Address - Street 1:741 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4001
Mailing Address - Country:US
Mailing Address - Phone:740-354-5622
Mailing Address - Fax:740-353-1275
Practice Address - Street 1:741 2ND ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4001
Practice Address - Country:US
Practice Address - Phone:740-354-5622
Practice Address - Fax:740-353-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
OH0201172503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2075098OtherPK
OH8187911Medicaid