Provider Demographics
NPI:1679616346
Name:S M PHARMACEUTICAL INC
Entity Type:Organization
Organization Name:S M PHARMACEUTICAL INC
Other - Org Name:TAMPA PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-345-9292
Mailing Address - Street 1:19100 VENTURA BLVD
Mailing Address - Street 2:STE L
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3239
Mailing Address - Country:US
Mailing Address - Phone:818-345-9292
Mailing Address - Fax:818-705-0526
Practice Address - Street 1:19100 VENTURA BLVD
Practice Address - Street 2:STE L
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3239
Practice Address - Country:US
Practice Address - Phone:818-345-9292
Practice Address - Fax:818-705-0526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY440393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0512423OtherNCPDP PROVIDER IDENTIFICATION NUMBER
CAPHA440390Medicaid
CAPHA440390Medicaid