Healthcare Provider Details

I. General information

NPI: 1497897714
Provider Name (Legal Business Name): SMITH DRUG & HOME MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S SECOND ST
BOONEVILLE MS
38829-3225
US

IV. Provider business mailing address

100 S SECOND ST
BOONEVILLE MS
38829-3225
US

V. Phone/Fax

Practice location:
  • Phone: 662-728-5322
  • Fax: 662-728-3187
Mailing address:
  • Phone: 662-728-5322
  • Fax: 662-728-3187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0018901.1
License Number StateMS

VIII. Authorized Official

Name: DR. JASON WHITE
Title or Position: PHARMACIST
Credential: PHARM. D.
Phone: 662-728-5322