NPIMap

Organization Active NPI

Smith's Food & Drug Centers Inc

Doing business as Fry's Pharmacy #693

  • Community/Retail Pharmacy
  • Queen Creek, AZ
National Provider Identifier
1417528324
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SMITH'S FOOD & DRUG CENTERS INC
Doing business as
Fry's Pharmacy #693
Practice address
25105 S. Ellsworth Rd
Queen Creek, AZ 85142
Phone
(480) 428-7616
Fax
(480) 428-7617
NPI assigned
Jul 2, 2021
Last updated
Dec 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lysette Seilhamer
Title
Manager of Licensing
Phone
(513) 762-1090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

25105 S. Ellsworth Rd
Queen Creek, AZ 85142

Mailing address

PO Box 2918
Hutchinson, KS 67504-2918

Other names 1

  • FRY'S PHARMACY #693 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050623000901 AZ Part B Supplier - Mass Immunization (Roster Biller Only) 4284674698 This NPI is an additional NPI on the enrollment
O20220223001902 AZ DME Supplier - PharmacyDME Supplier - Grocery Store 4284674698 Practice locations: Queen Creek, AZ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
03D2240054Fry's Pharmacy #69325105 S Ellsworth Rd, Queen Creek, AZ 85142Certificate of waiverOct 14, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Fry's Pharmacy 6600069325105 S Ellsworth Rd, Queen Creek, AZ 85142-1563(480) 428-7616 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignmentParticipating since Jul 7, 2025

National Provider Directory

National Provider Directory
Tax ID family
Smith's Drug Store 57274 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

25105 S Ellsworth Rd
Queen Creek, AZ 85142
Phone (480) 428-7616

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1417528324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2918",
            "city": "HUTCHINSON",
            "state": "KS",
            "postal_code": "675042918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25105 S. ELLSWORTH RD",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "85142",
            "telephone_number": "480-428-7616",
            "fax_number": "480-428-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMITH'S FOOD & DRUG CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-02",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "SEILHAMER",
        "authorized_official_first_name": "LYSETTE",
        "authorized_official_title_or_position": "MANAGER OF LICENSING",
        "authorized_official_telephone_number": "513-762-1090"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FRY'S PHARMACY #693",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FRY'S PHARMACY #693",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Queen Creek, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.