Provider Demographics
NPI:1942453634
Name:HEALTHSMART PHARMACY, INC
Entity Type:Organization
Organization Name:HEALTHSMART PHARMACY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:D
Authorized Official - Last Name:KANERIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:734-678-9763
Mailing Address - Street 1:10824 BELLEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-5304
Mailing Address - Country:US
Mailing Address - Phone:734-699-2228
Mailing Address - Fax:734-699-2336
Practice Address - Street 1:10824 BELLEVILLE RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-5304
Practice Address - Country:US
Practice Address - Phone:734-699-2228
Practice Address - Fax:734-699-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6459810001Medicare NSC