=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215952833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMITHS FOOD & DRUG CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 08/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4440 N RANCHO DR
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89130-3406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-645-6200
-----------------------------------------------------
Fax | 702-645-7399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30550 MS 44010 010C
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84130-0550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-974-1402
-----------------------------------------------------
Fax | 801-973-1704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER OF PHARMACY CREDENTIALING
-----------------------------------------------------
Name | KARLA LANGWORTHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-698-1878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH00770
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------