Provider Demographics
NPI:1619961182
Name:SMITHS PHARMACY & HOME HEALTH CARE CENTER OF KENBRIDGE INC
Entity Type:Organization
Organization Name:SMITHS PHARMACY & HOME HEALTH CARE CENTER OF KENBRIDGE INC
Other - Org Name:SMITH'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:REITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-676-2266
Mailing Address - Street 1:PO BOX 538
Mailing Address - Street 2:
Mailing Address - City:KENBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:23944-0538
Mailing Address - Country:US
Mailing Address - Phone:434-676-2266
Mailing Address - Fax:434-676-1052
Practice Address - Street 1:111 S BROAD STREET
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944
Practice Address - Country:US
Practice Address - Phone:434-676-2266
Practice Address - Fax:434-676-1052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
VA02010023753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009137564Medicaid
VA8505497Medicaid
2102659OtherPK
0166140001Medicare NSC