Provider Demographics
NPI:1568569481
Name:SMITH APOTHECARY CORP
Entity Type:Organization
Organization Name:SMITH APOTHECARY CORP
Other - Org Name:SMITH BROTHERS DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:THESING
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:856-779-8300
Mailing Address - Street 1:25 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE SHADE
Mailing Address - State:NJ
Mailing Address - Zip Code:08052
Mailing Address - Country:US
Mailing Address - Phone:856-779-8300
Mailing Address - Fax:856-779-9022
Practice Address - Street 1:25 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:MAPLE SHADE
Practice Address - State:NJ
Practice Address - Zip Code:08052
Practice Address - Country:US
Practice Address - Phone:856-779-8300
Practice Address - Fax:856-779-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NJ28RS004154003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0739251Medicaid
NJ7817040001OtherMEDICARE DME
2054296OtherPK
NJ4397606Medicaid