Provider Demographics
NPI:1972573350
Name:SMITH-MCKENNEY CO INC
Entity type:Organization
Organization Name:SMITH-MCKENNEY CO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:S
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-633-2115
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40066-0547
Mailing Address - Country:US
Mailing Address - Phone:502-722-2115
Mailing Address - Fax:502-633-1133
Practice Address - Street 1:141 BUCK CREEK RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:KY
Practice Address - Zip Code:40067-6674
Practice Address - Country:US
Practice Address - Phone:502-633-2115
Practice Address - Fax:502-633-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
KYP068843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY54005707Medicaid
1828106OtherNCPDP PROVIDER IDENTIFICATION NUMBER