Provider Demographics
NPI:1114681012
Name:SMITHWAY PHARMACY, LLC
Entity Type:Organization
Organization Name:SMITHWAY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:MISSY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:417-298-1801
Mailing Address - Street 1:100 W TILDEN ST
Mailing Address - Street 2:
Mailing Address - City:HUMANSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65674-8229
Mailing Address - Country:US
Mailing Address - Phone:417-754-1501
Mailing Address - Fax:417-754-1505
Practice Address - Street 1:100 W TILDEN ST
Practice Address - Street 2:
Practice Address - City:HUMANSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65674-8229
Practice Address - Country:US
Practice Address - Phone:417-754-1501
Practice Address - Fax:417-754-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-26
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy