Provider Demographics
NPI:1235675182
Name:SMITH MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:SMITH MANAGEMENT SERVICES LLC
Other - Org Name:MARBLE WORKS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PURSCELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-388-1575
Mailing Address - Street 1:99 MAPLE ST STE 19
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1595
Mailing Address - Country:US
Mailing Address - Phone:802-458-3100
Mailing Address - Fax:802-388-0872
Practice Address - Street 1:99 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1595
Practice Address - Country:US
Practice Address - Phone:802-388-3784
Practice Address - Fax:802-388-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT038.01274453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166860OtherPK