Provider Demographics
NPI:1881755957
Name:SMITH PHARMACY INC
Entity type:Organization
Organization Name:SMITH PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:YAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-617-9875
Mailing Address - Street 1:1107 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1016
Mailing Address - Country:US
Mailing Address - Phone:323-461-8331
Mailing Address - Fax:323-461-8332
Practice Address - Street 1:1107 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1016
Practice Address - Country:US
Practice Address - Phone:323-461-8331
Practice Address - Fax:323-461-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY483443336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111830OtherPK