Healthcare Provider Details

I. General information

NPI: 1386661254
Provider Name (Legal Business Name): HEALTH-SMART PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5809 HIGHWAY 189 N
BAKER FL
32531-2501
US

IV. Provider business mailing address

5809 HIGHWAY 189 N
BAKER FL
32531-2501
US

V. Phone/Fax

Practice location:
  • Phone: 850-537-6266
  • Fax: 850-537-6350
Mailing address:
  • Phone: 850-537-6266
  • Fax: 850-537-6350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH13367
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH13367
License Number StateFL

VIII. Authorized Official

Name: MRS. MELODY THOMPSON BOLTON
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 850-537-6266