Provider Demographics
NPI:1780225003
Name:NICHOLAS L SMITH PHARMACY LLC
Entity Type:Organization
Organization Name:NICHOLAS L SMITH PHARMACY LLC
Other - Org Name:SMITH PHARMACY - LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHARM D
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-788-8888
Mailing Address - Street 1:1800 FREEDOM RD STE D
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-3200
Mailing Address - Country:US
Mailing Address - Phone:920-788-8888
Mailing Address - Fax:920-788-8883
Practice Address - Street 1:1800 FREEDOM RD STE D
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-3200
Practice Address - Country:US
Practice Address - Phone:920-788-8888
Practice Address - Fax:920-788-8883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICHOLAS L SMITH PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-08
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy