Provider Demographics
NPI:1811593791
Name:SMILE RX PHARMACY
Entity Type:Organization
Organization Name:SMILE RX PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-807-4157
Mailing Address - Street 1:490 IH 10 N STE 400
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1819
Mailing Address - Country:US
Mailing Address - Phone:409-554-8168
Mailing Address - Fax:
Practice Address - Street 1:490 IH 10 N STE 400
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1819
Practice Address - Country:US
Practice Address - Phone:409-554-8168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33536OtherTEXAS STATE BOARD PHARMACY LICENSE