Provider Demographics
NPI:1215952833
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:MANAGER OF PHARMACY CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGWORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-698-1878
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 1:4440 N RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3406
Practice Address - Country:US
Practice Address - Phone:702-645-6200
Practice Address - Fax:702-645-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
NVPH007703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2056670OtherPK
NV1215952833Medicaid
NV003302553Medicaid
V100887Medicare PIN
NV1215952833Medicaid
NV003302553Medicaid
V100887Medicare PIN