Healthcare Provider Details

I. General information

NPI: 1356354971
Provider Name (Legal Business Name): SMITH DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MAIN ST
RIENZI MS
38865-9144
US

IV. Provider business mailing address

PO BOX 138
RIENZI MS
38865-0138
US

V. Phone/Fax

Practice location:
  • Phone: 662-462-5314
  • Fax: 662-462-5600
Mailing address:
  • Phone: 662-462-5314
  • Fax: 662-462-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00968/01.1
License Number StateMS

VIII. Authorized Official

Name: MISS TREVOR ALAN WILLIAMS
Title or Position: OWNER/PHARMACIST
Credential: RPH
Phone: 662-462-5314