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General NPI Number Information
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NPI Number | 1619263571
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Entity Type | Organization
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Legal Business Name | SMITH'S FOOD AND DRUG PHARMACY
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Dates
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Enumeration Date | 06/20/2011
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 400 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4367
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Country | US
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Telephone | 208-529-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 400 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4367
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Country | US
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Telephone | 208-529-5300
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Fax |
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Authorized Official
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Title or Position | PHARMACY MGR
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Name | MR. TOMMY H. LEW
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Credential | REGISTERED PHARMACIS
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Telephone | 208-529-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 1288CP
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License Number State | ID
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