Provider Demographics
NPI:1386661254
Name:HEALTH-SMART PHARMACY INC.
Entity Type:Organization
Organization Name:HEALTH-SMART PHARMACY INC.
Other - Org Name:HEALTH SMART PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:THOMPSON
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:850-537-6266
Mailing Address - Street 1:5809 HIGHWAY 189 N
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:FL
Mailing Address - Zip Code:32531-2501
Mailing Address - Country:US
Mailing Address - Phone:850-537-6266
Mailing Address - Fax:850-537-6350
Practice Address - Street 1:5809 HIGHWAY 189 N
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:FL
Practice Address - Zip Code:32531-2501
Practice Address - Country:US
Practice Address - Phone:850-537-6266
Practice Address - Fax:850-537-6350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH13367332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102978900Medicaid
FL102978900Medicaid