Provider Demographics
NPI:1891795266
Name:SMITH-MCKENNEY COMPANY INCORPORATED
Entity Type:Organization
Organization Name:SMITH-MCKENNEY COMPANY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:S
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:HAYSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:502-633-2115
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40066-0547
Mailing Address - Country:US
Mailing Address - Phone:502-633-2115
Mailing Address - Fax:502-633-1133
Practice Address - Street 1:16 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1745
Practice Address - Country:US
Practice Address - Phone:502-633-2115
Practice Address - Fax:502-633-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY332B00000X
KYPO6369333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000065348OtherANTHEM BCBS
1068524OtherPASSPORT
1068524OtherPASSPORT
KY0187000002Medicare NSC