Provider Demographics
NPI:1528059938
Name:S & M PHARMACY INC.
Entity type:Organization
Organization Name:S & M PHARMACY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-520-5175
Mailing Address - Street 1:4410 N MIDKIFF RD
Mailing Address - Street 2:STE D-207
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-4246
Mailing Address - Country:US
Mailing Address - Phone:432-520-5175
Mailing Address - Fax:432-689-8518
Practice Address - Street 1:4410 N MIDKIFF RD
Practice Address - Street 2:STE D-207
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-4246
Practice Address - Country:US
Practice Address - Phone:432-520-5175
Practice Address - Fax:432-689-8518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80254332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0759680002Medicare ID - Type Unspecified