Provider Demographics
NPI:1154348779
Name:SMITHS FOOD & DRUG CENTERS INC
Entity type:Organization
Organization Name:SMITHS FOOD & DRUG CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY LICENSING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZACH
Authorized Official - Middle Name:
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-762-1019
Mailing Address - Street 1:PO BOX 30550
Mailing Address - Street 2:MS 44010 010C
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84130-0550
Mailing Address - Country:US
Mailing Address - Phone:801-974-1402
Mailing Address - Fax:801-973-1704
Practice Address - Street 1:6150 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-2280
Practice Address - Country:US
Practice Address - Phone:702-876-8753
Practice Address - Fax:702-873-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NVPH017703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2051653OtherPK
NV002802656Medicaid
NV003302656Medicaid
2051653OtherPK
NV002802656Medicaid
P00327584Medicare PIN