Healthcare Provider Details

I. General information

NPI: 1891879995
Provider Name (Legal Business Name): SMITH-LOCKWOOD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 S MARBLE STREET ROCKM
ROCKMART GA
30153
US

IV. Provider business mailing address

PO BOX 308 114 S MARBLE ST
ROCKMART GA
30153-0308
US

V. Phone/Fax

Practice location:
  • Phone: 770-684-7889
  • Fax: 770-684-1550
Mailing address:
  • Phone: 770-684-6573
  • Fax: 770-684-4553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00035879
License Number StateGA

VIII. Authorized Official

Name: DAVID NELSON VEST
Title or Position: CO-OWNER
Credential: RPH
Phone: 770-684-6573