Healthcare Provider Details

I. General information

NPI: 1275833311
Provider Name (Legal Business Name): SMITHS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 10/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 WYOMING BLVD NE STE A
ALBUQUERQUE NM
87113-1947
US

IV. Provider business mailing address

8100 WYOMING BLVD NE STE A
ALBUQUERQUE NM
87113-1947
US

V. Phone/Fax

Practice location:
  • Phone: 505-857-9783
  • Fax: 505-857-9835
Mailing address:
  • Phone: 505-857-9783
  • Fax: 505-857-9835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006655
License Number StateNM

VIII. Authorized Official

Name: JEANNIE GOODRICH
Title or Position: DISTRICT MANAGER
Credential: RPH
Phone: 505-823-6721