Provider Demographics
NPI:1356354971
Name:SMITH DRUG CO INC
Entity type:Organization
Organization Name:SMITH DRUG CO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-462-5314
Mailing Address - Street 1:PO BOX 138
Mailing Address - Street 2:
Mailing Address - City:RIENZI
Mailing Address - State:MS
Mailing Address - Zip Code:38865-0138
Mailing Address - Country:US
Mailing Address - Phone:662-462-5314
Mailing Address - Fax:662-462-5600
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:RIENZI
Practice Address - State:MS
Practice Address - Zip Code:38865-9144
Practice Address - Country:US
Practice Address - Phone:662-462-5314
Practice Address - Fax:662-462-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MS00968/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00968OtherSTATE PHARMACY BOARD
MS00092177Medicaid
2506915OtherNCPDP