MEDICARE: SMITHERS FAMILY PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508339482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITHERS FAMILY PHARMACY

Provider Business Mailing Address
First Line	:	505 VIRGINIA ST BOX 58
Second Line	:
City	:	SMITHERS
State	:	WV
Zip	:	25186-8603
Country	:	US
Telephone Number	:	304-981-2323
Fax Number	:	304-981-2122

Provider Business Practice Location Address
First Line	:	505 VIRGINIA ST
Second Line	:
City	:	SMITHERS
State	:	WV
Zip	:	25186-8603
Country	:	US
Telephone Number	:	304-981-2323
Fax Number	:	304-981-2122

Authorized Official
Title or Position	:	TREASURER
Name	:	EARL TOM BENNETT
Credential	:	RPH
Telephone Number	:	304-549-9656

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	04/11/2020

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Directions to “SMITHERS FAMILY PHARMACY ” Practice Location

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