MEDICARE: SMITH'S PHARMACY OF MCRAE, L.L.C.

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	PHRE008727	GA

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	:	1669438560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH'S PHARMACY OF MCRAE, L.L.C.

Provider Business Mailing Address
First Line	:	112 W OAK STREET
Second Line	:
City	:	MC RAE
State	:	GA
Zip	:	31055
Country	:	US
Telephone Number	:	229-868-2580
Fax Number	:	229-868-2529

Provider Business Practice Location Address
First Line	:	112 W OAK STREET
Second Line	:
City	:	MC RAE
State	:	GA
Zip	:	31055
Country	:	US
Telephone Number	:	229-868-2580
Fax Number	:	229-868-2529

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	DR. DANNY CARLTON SMITH JR.
Credential	:
Telephone Number	:	229-868-2580

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	04/17/2009

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