Provider Demographics
NPI:1528416575
Name:SMART RX PHARMACY, INC.
Entity Type:Organization
Organization Name:SMART RX PHARMACY, INC.
Other - Org Name:SMART RX PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER & CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-617-6059
Mailing Address - Street 1:5703 RED BUG LAKE RD # 256
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4969
Mailing Address - Country:US
Mailing Address - Phone:407-536-5696
Mailing Address - Fax:407-900-2656
Practice Address - Street 1:235 W HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3027
Practice Address - Country:US
Practice Address - Phone:407-536-5696
Practice Address - Fax:407-900-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH301233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160318OtherPK