=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992551329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMITH'S FOOD & DRUG CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2024
-----------------------------------------------------
Last Update Date | 04/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11350 W TANGERINE RD
-----------------------------------------------------
City | MARANA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85653-1371
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-635-6805
-----------------------------------------------------
Fax | 520-762-4530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1014 VINE ST
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45202-1141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-246-3091
-----------------------------------------------------
Fax | 513-762-1092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSING ASP
-----------------------------------------------------
Name | VICTORIA BONE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-246-3091
-----------------------------------------------------
=====================================================
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 | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------