Provider Demographics
NPI:1750765137
Name:SMITHS STATION PHARMACY LLC
Entity type:Organization
Organization Name:SMITHS STATION PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOURNOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-573-6106
Mailing Address - Street 1:2828 LEE ROAD 430
Mailing Address - Street 2:
Mailing Address - City:SMITHS STATION
Mailing Address - State:AL
Mailing Address - Zip Code:36877-2571
Mailing Address - Country:US
Mailing Address - Phone:334-408-6106
Mailing Address - Fax:334-408-6108
Practice Address - Street 1:2828 LEE ROAD 430
Practice Address - Street 2:
Practice Address - City:SMITHS STATION
Practice Address - State:AL
Practice Address - Zip Code:36877-2571
Practice Address - Country:US
Practice Address - Phone:334-408-6106
Practice Address - Fax:334-408-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-15
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1144993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153484OtherPK
AL179255Medicaid