Provider Demographics
NPI:1528113263
Name:SMOTHERMAN INC
Entity type:Organization
Organization Name:SMOTHERMAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYKAY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:318-495-5915
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:URANIA
Mailing Address - State:LA
Mailing Address - Zip Code:71480-0640
Mailing Address - Country:US
Mailing Address - Phone:318-495-5407
Mailing Address - Fax:318-495-5421
Practice Address - Street 1:2164 E HARDNTER DR
Practice Address - Street 2:
Practice Address - City:URANIA
Practice Address - State:LA
Practice Address - Zip Code:71480
Practice Address - Country:US
Practice Address - Phone:318-495-5407
Practice Address - Fax:318-495-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY001516IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1251909Medicaid
1917270OtherNCPDP PROVIDER IDENTIFICATION NUMBER