Healthcare Provider Details

I. General information

NPI: 1417344615
Provider Name (Legal Business Name): SMITH STREET RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2015
Last Update Date: 04/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 MANSION ST # 3
POUGHKEEPSIE NY
12601-2623
US

IV. Provider business mailing address

269 MANSION ST # 3
POUGHKEEPSIE NY
12601-2623
US

V. Phone/Fax

Practice location:
  • Phone: 845-471-6440
  • Fax: 845-471-7258
Mailing address:
  • Phone: 845-471-6440
  • Fax: 845-471-7258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. RAVI KUMAR CHENNA
Title or Position: PRESIDENT
Credential:
Phone: 845-471-6440