Provider Demographics
NPI:1518265628
Name:SMC PHARMACY LLC
Entity Type:Organization
Organization Name:SMC PHARMACY LLC
Other - Org Name:SMC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTIOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-242-8969
Mailing Address - Street 1:1908 SANTA MONICA BLVD
Mailing Address - Street 2:STE 4
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1927
Mailing Address - Country:US
Mailing Address - Phone:310-315-9999
Mailing Address - Fax:310-315-9990
Practice Address - Street 1:1908 SANTA MONICA BLVD
Practice Address - Street 2:STE 4
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1927
Practice Address - Country:US
Practice Address - Phone:310-315-9999
Practice Address - Fax:310-315-9990
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIORX LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-14
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518265628Medicaid
CA57575OtherCA BOARD OF PHARMACY PHY 57575