Healthcare Provider Details

I. General information

NPI: 1972573350
Provider Name (Legal Business Name): SMITH-MCKENNEY CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 BUCK CREEK RD
SIMPSONVILLE KY
40067-6674
US

IV. Provider business mailing address

PO BOX 547
SHELBYVILLE KY
40066-0547
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-2115
  • Fax: 502-633-9499
Mailing address:
  • Phone: 502-722-2115
  • Fax: 502-633-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP06884
License Number StateKY

VIII. Authorized Official

Name: S HAYSE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 502-633-2115