Provider Demographics
NPI:1164942041
Name:SMPE INC
Entity Type:Organization
Organization Name:SMPE INC
Other - Org Name:MED-CHOICE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-463-6979
Mailing Address - Street 1:2300 W MORTON ST STE 121
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-1600
Mailing Address - Country:US
Mailing Address - Phone:903-463-6979
Mailing Address - Fax:903-463-6976
Practice Address - Street 1:2300 W MORTON ST STE 121
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-1600
Practice Address - Country:US
Practice Address - Phone:903-463-6979
Practice Address - Fax:903-463-6976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
TX255593336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2169897OtherPK
TX145811Medicaid
2169897OtherPK