Provider Demographics
NPI:1346786290
Name:SMITH MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:SMITH MANAGEMENT SERVICES, LLC
Other - Org Name:WILCOX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEIDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:980-422-3584
Mailing Address - Street 1:99 MAPLE STREET
Mailing Address - Street 2:STE 19
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-458-3102
Mailing Address - Fax:802-388-0872
Practice Address - Street 1:252 STRATTON RD
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-775-3351
Practice Address - Fax:802-774-5052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMITH MANAGEMENT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-17
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT038.0125476333600000X
3336C0003X, 3336C0004X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167101OtherPK