Smith Drug Company of Pleasant Grove
Organization Active NPI Community/Retail Pharmacy · Pleasant GRV, UT
NPI 1588694228 · NPPES record last updated Aug 25, 2016
Key facts
- NPI
- 1588694228
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 0089917035 (UT)
- Legal business name
- SMITH DRUG COMPANY OF PLEASANT GROVE
- Practice address
- 10 S Main St
Pleasant GRV, UT 84062-2630 - Phone
- (801) 785-3221
- NPI assigned
- Jul 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Kristine Pence, CPHT
- Title
- Owner
- Phone
- (801) 785-3221
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110620000239 | UT | Part B Supplier - Mass Immunization (Roster Biller Only) | 8325226418 | Practice locations: Pleasant Grove, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 0089917035 | UT | Yes |
Addresses
Primary practice location
10 S Main St
Pleasant GRV, UT 84062-2630
Mailing address
10 S Main St
Pleasant GRV, UT 84062-2630
Phone (801) 785-3221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4600664 | Other | UT | NABP PROVIDER NUMBER |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.