Provider Demographics
NPI:1881038230
Name:SMART PHARMACY LLC
Entity Type:Organization
Organization Name:SMART PHARMACY LLC
Other - Org Name:SMART PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:352-256-1579
Mailing Address - Street 1:10 W PALMER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-3046
Mailing Address - Country:US
Mailing Address - Phone:828-369-3784
Mailing Address - Fax:828-368-3791
Practice Address - Street 1:10 W PALMER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-3046
Practice Address - Country:US
Practice Address - Phone:828-369-3784
Practice Address - Fax:828-368-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-28
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NC115783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140316OtherPK
7387240001Medicare NSC