Healthcare Provider Details

I. General information

NPI: 1174548705
Provider Name (Legal Business Name): SMITHS FOOD & DRUG CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CALIFORNIA ST
SOCORRO NM
87801-4269
US

IV. Provider business mailing address

PO BOX 30550 MS 44010 010C
SALT LAKE CITY UT
84130-0550
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-9495
  • Fax: 575-838-4916
Mailing address:
  • Phone: 801-974-1402
  • Fax: 801-973-1704

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 NumberPH00002367
License Number StateNM

VIII. Authorized Official

Name: KARLA LANGWORTHY
Title or Position: MANAGER OF PHARMACY CREDENTIALING
Credential:
Phone: 513-698-1878