MEDICARE: SMITH PHARMACY INC

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	PHY48344	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2111830	OTHER		PK

General Provider Information

NPI Number	:	1881755957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH PHARMACY INC

Provider Business Mailing Address
First Line	:	1107 N WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1016
Country	:	US
Telephone Number	:	323-461-8331
Fax Number	:	323-461-8332

Provider Business Practice Location Address
First Line	:	1107 N WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1016
Country	:	US
Telephone Number	:	323-461-8331
Fax Number	:	323-461-8332

Authorized Official
Title or Position	:	OWNER
Name	:	JENNY YAM
Credential	:
Telephone Number	:	626-617-9875

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	11/09/2015

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Directions to “SMITH PHARMACY INC ” Practice Location

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