Healthcare Provider Details

I. General information

NPI: 1508339482
Provider Name (Legal Business Name): SMITHERS FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 04/11/2020
Certification Date: 04/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 VIRGINIA ST
SMITHERS WV
25186-8603
US

IV. Provider business mailing address

505 VIRGINIA ST BOX 58
SMITHERS WV
25186-8603
US

V. Phone/Fax

Practice location:
  • Phone: 304-981-2323
  • Fax: 304-981-2122
Mailing address:
  • Phone: 304-981-2323
  • Fax: 304-981-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: EARL TOM BENNETT
Title or Position: TREASURER
Credential: RPH
Phone: 304-549-9656