Healthcare Provider Details

I. General information

NPI: 1154348779
Provider Name (Legal Business Name): SMITHS FOOD & DRUG CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6150 W FLAMINGO RD
LAS VEGAS NV
89103-2280
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: 702-876-8753
  • Fax: 702-873-7159
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 TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH01770
License Number StateNV

VIII. Authorized Official

Name: ZACH STONE
Title or Position: PHARMACY LICENSING MANAGER
Credential:
Phone: 513-762-1019