Provider Demographics
NPI:1487193496
Name:SMP PHARMACY SOLUTIONS LLC
Entity Type:Organization
Organization Name:SMP PHARMACY SOLUTIONS LLC
Other - Org Name:SMP PHARMACY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DATA & COMPLIANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANTES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-740-9696
Mailing Address - Street 1:6050 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5042
Mailing Address - Country:US
Mailing Address - Phone:786-361-1111
Mailing Address - Fax:855-447-6637
Practice Address - Street 1:6050 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5042
Practice Address - Country:US
Practice Address - Phone:786-361-1111
Practice Address - Fax:855-447-6637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH253223336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014725900Medicaid
2167953OtherPK
2167953OtherPK