Provider Demographics
NPI:1669438560
Name:SMITH'S PHARMACY OF MCRAE, L.L.C.
Entity Type:Organization
Organization Name:SMITH'S PHARMACY OF MCRAE, L.L.C.
Other - Org Name:SMITH'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:CARLTON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:229-868-2580
Mailing Address - Street 1:112 W OAK STREET
Mailing Address - Street 2:
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055
Mailing Address - Country:US
Mailing Address - Phone:229-868-2580
Mailing Address - Fax:229-868-2529
Practice Address - Street 1:112 W OAK STREET
Practice Address - Street 2:
Practice Address - City:MC RAE
Practice Address - State:GA
Practice Address - Zip Code:31055
Practice Address - Country:US
Practice Address - Phone:229-868-2580
Practice Address - Fax:229-868-2529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0087273336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA218161597AMedicaid
GA4802840001Medicare NSC
GA218161597AMedicaid