Provider Demographics
NPI:1497897714
Name:SMITH DRUG & HOME MEDICAL, INC.
Entity Type:Organization
Organization Name:SMITH DRUG & HOME MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:662-728-5322
Mailing Address - Street 1:100 S SECOND ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-3225
Mailing Address - Country:US
Mailing Address - Phone:662-728-5322
Mailing Address - Fax:662-728-3187
Practice Address - Street 1:100 S SECOND ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3225
Practice Address - Country:US
Practice Address - Phone:662-728-5322
Practice Address - Fax:662-728-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0018901.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440530Medicaid
MS00440530Medicaid
5632840001Medicare NSC