Provider Demographics
NPI:1891879995
Name:SMITH-LOCKWOOD, INC.
Entity Type:Organization
Organization Name:SMITH-LOCKWOOD, INC.
Other - Org Name:SMITH-LOCKWOOD DRUGS AND JEWELRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:VEST
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-684-6573
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:114 S MARBLE ST
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-0308
Mailing Address - Country:US
Mailing Address - Phone:770-684-6573
Mailing Address - Fax:770-684-4553
Practice Address - Street 1:114 S MARBLE STREET
Practice Address - Street 2:ROCKM
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153
Practice Address - Country:US
Practice Address - Phone:770-684-7889
Practice Address - Fax:770-684-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000358793336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005696OtherSTATE LICENSE NUMBER
GA000035879AMedicaid
GA8442448-YIOtherGA STATE TAX ID#
GA8442448-YIOtherGA STATE TAX ID#
GA000035879AMedicaid
GA8442448-YIOtherGA STATE TAX ID#