Provider Demographics
NPI:1033133822
Name:SMITH, JAN D
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 RICHWOOD DOWN DR
Mailing Address - Street 2:
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-4711
Mailing Address - Country:US
Mailing Address - Phone:864-833-4000
Mailing Address - Fax:864-833-6459
Practice Address - Street 1:216 S BROAD ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-2505
Practice Address - Country:US
Practice Address - Phone:864-833-4000
Practice Address - Fax:864-833-6459
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC007944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist