Healthcare Provider Details

I. General information

NPI: 1154314672
Provider Name (Legal Business Name): SMITH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 COURTHOUSE SQUARE
BURKESVILLE KY
42717
US

IV. Provider business mailing address

PO BOX 247
BURKESVILLE KY
42717-0247
US

V. Phone/Fax

Practice location:
  • Phone: 270-864-2231
  • Fax: 270-864-2299
Mailing address:
  • Phone: 270-864-2231
  • Fax: 270-864-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP06686
License Number StateKY

VIII. Authorized Official

Name: MR. WENDELL D BUTLER
Title or Position: PHARMACIST OWNER
Credential: RPH
Phone: 270-864-2231