Provider Demographics
NPI:1790796340
Name:SMITH-TURNER DRUG STORE, INC
Entity Type:Organization
Organization Name:SMITH-TURNER DRUG STORE, INC
Other - Org Name:SMITH-TURNER DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:423-733-2322
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-0378
Mailing Address - Country:US
Mailing Address - Phone:423-733-2322
Mailing Address - Fax:423-733-2140
Practice Address - Street 1:140 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3849
Practice Address - Country:US
Practice Address - Phone:423-733-2322
Practice Address - Fax:423-733-2140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336L0003X
TN543336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2089440OtherPK
TN9448755Medicaid
TN4419621Medicaid
TN4419621Medicaid