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General NPI Number Information
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NPI Number | 1780848804
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Entity Type | Organization
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Legal Business Name | HEALTHSMART PHARMACY LLC
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 12/02/2009
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Provider Practice Location Address
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Address Line | 108 LEANING OAK DR
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City | MOORESVILLE
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State | NC
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Zip | 28117
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Country | US
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Telephone | 704-658-1184
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Fax | 794-658-1184
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Provider Business Mailing Address
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Address Line | 108 LEANING OAK DR
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City | MOORESVILLE
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State | NC
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Zip | 28117
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Country | US
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Telephone | 704-658-1184
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Fax | 794-658-1184
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Authorized Official
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Title or Position | MANAGER
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Name | DOUG BALOG
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Credential |
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Telephone | 704-906-0281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 10131
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License Number State | NC
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