Provider Demographics
NPI:1962556225
Name:SMITH & STEWART DRUG
Entity type:Organization
Organization Name:SMITH & STEWART DRUG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHARM D
Authorized Official - Phone:706-886-3141
Mailing Address - Street 1:102 N SAGE ST
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-3678
Mailing Address - Country:US
Mailing Address - Phone:706-886-3141
Mailing Address - Fax:706-886-4000
Practice Address - Street 1:102 SAGE ST N
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-2336
Practice Address - Country:US
Practice Address - Phone:706-886-3141
Practice Address - Fax:706-886-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE006339333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1115054OtherNABP #
GAGA6339OtherSTATE PHARMACY LICENSE #
GA000191023AMedicaid
GAAS9117070OtherDEA #
GA000191023AMedicaid