Healthcare Provider Details

I. General information

NPI: 1417939794
Provider Name (Legal Business Name): SMA HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 WILLIS AVE BLDG. 2
DAYTONA BEACH FL
32114-2810
US

IV. Provider business mailing address

1220 WILLIS AVE BLDG. 2
DAYTONA BEACH FL
32114-2810
US

V. Phone/Fax

Practice location:
  • Phone: 386-236-3188
  • Fax: 386-239-6123
Mailing address:
  • Phone: 386-236-3188
  • Fax: 386-239-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0010338
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NICOLE SPROUL
Title or Position: PAHRMACIST IN CHARGE
Credential: R.PH,, C.PH.
Phone: 386-236-1658