NPIMap

Organization Active NPI

Smiths Food & Drug Centers Inc

Doing business as Fry's Pharmacy #678

  • Community/Retail Pharmacy
  • Surprise, AZ
National Provider Identifier
1699404350
Registry record updated Mar 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SMITHS FOOD & DRUG CENTERS INC
Doing business as
Fry's Pharmacy #678
Practice address
16400 W. Pat Tillman Blvd.
Surprise, AZ 85387
Phone
(480) 863-5620
Fax
(480) 863-5621
NPI assigned
Jun 8, 2022
Last updated
Mar 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2023

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
(515) 762-1090

Specialties & licenses 2

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

Addresses

Primary practice location

16400 W. Pat Tillman Blvd.
Surprise, AZ 85387

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019

Other names 1

  • Fry's Pharmacy #678 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
O20230518003443 AZ DME Supplier - PharmacyDME Supplier - Grocery Store 4284674698 Practice locations: Surprise, 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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Fry's Pharmacy #67816400 W Pat Tillman Blvd, Surprise, AZ 85387-1705(480) 863-5620 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
Smiths Pharmacy 80274 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

16400 W Pat Tillman Blvd
Surprise, AZ 85387
Phone (480) 863-5620

NPI Registry JSON

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678406400000",
    "number": "1699404350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16400 W. PAT TILLMAN BLVD.",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "85387",
            "telephone_number": "480-863-5620",
            "fax_number": "480-863-5621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMITHS FOOD & DRUG CENTERS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-08",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-08",
        "status": "A",
        "authorized_official_last_name": "SEILHAMER",
        "authorized_official_first_name": "LYSETTE",
        "authorized_official_title_or_position": "MANAGER OF LICENSING",
        "authorized_official_telephone_number": "515-762-1090"
    },
    "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 #678",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fry's Pharmacy #678",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Surprise, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; 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.