Healthcare Provider Details

I. General information

NPI: 1093756884
Provider Name (Legal Business Name): SMITHS FOOD & DRUG CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 W UNIVERSITY DR
MESA AZ
85201-5555
US

IV. Provider business mailing address

500 S 99TH AVE
TOLLESON AZ
85353-9700
US

V. Phone/Fax

Practice location:
  • Phone: 480-844-7197
  • Fax: 480-844-4841
Mailing address:
  • Phone: 623-907-4933
  • Fax: 623-907-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberY003097
License Number StateAZ

VIII. Authorized Official

Name: KARLA LANGWORTHY
Title or Position: PHARMACY LICENSING MANAGER
Credential:
Phone: 513-698-1878