Healthcare Provider Details

I. General information

NPI: 1831114461
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: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 W 13400 S
HERRIMAN UT
84096-6919
US

IV. Provider business mailing address

PO BOX 842772
BOSTON MA
02284-2772
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-8336
  • Fax: 801-254-8230
Mailing address:
  • Phone: 513-762-1019
  • Fax: 513-762-1092

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 Number53910731703
License Number StateUT

VIII. Authorized Official

Name: ALLISON MUENNICH
Title or Position: MANAGER OF PHARMACY LICENSING
Credential:
Phone: 513-762-1019