Provider Demographics
NPI:1730121302
Name:SMITHS FOOD & DRUG CENTERS INC
Entity Type:Organization
Organization Name:SMITHS FOOD & DRUG CENTERS INC
Other - Org Name:FRYS FOOD AND DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF PHARMACY CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-698-1878
Mailing Address - Street 1:500 S 99TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-9700
Mailing Address - Country:US
Mailing Address - Phone:623-907-4933
Mailing Address - Fax:623-907-4990
Practice Address - Street 1:4949 W RAY RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2064
Practice Address - Country:US
Practice Address - Phone:480-940-7797
Practice Address - Fax:480-705-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
AZY0030813336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ494617Medicaid
1989709OtherPK
Z133030Medicare PIN
0365690231Medicare NSC