Organization
CHRYSTAL INC
Active
Other names
SMITH PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CLARENCE SMITH RPH (PRESIDENT)
(931) 526-4612
Entity
Organization
Contact information
Practice address
100 W 3RD ST, COOKEVILLE, TN 38501-2495
(931) 526-4312
Mailing address
PO BOX 2707, COOKEVILLE, TN 38502-2707
(931) 260-9589
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2271
TN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3561654
—
TN
01
—
4426602
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/22/2005
Last updated
01/26/2011
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