Provider Demographics
NPI:1063071637
Name:SMART RX LLC
Entity type:Organization
Organization Name:SMART RX LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLI
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHAYTOU
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:313-530-9595
Mailing Address - Street 1:25464 VAN BORN RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1702
Mailing Address - Country:US
Mailing Address - Phone:313-551-4949
Mailing Address - Fax:313-436-4970
Practice Address - Street 1:25464 VAN BORN RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125
Practice Address - Country:US
Practice Address - Phone:313-530-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy