Provider Demographics
NPI:1033327259
Name:SMITH, DONALD PATRICK (PD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:PATRICK
Last Name:SMITH
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:WALDRON
Mailing Address - State:AR
Mailing Address - Zip Code:72958-0855
Mailing Address - Country:US
Mailing Address - Phone:479-637-3301
Mailing Address - Fax:
Practice Address - Street 1:1125 W 2ND ST
Practice Address - Street 2:
Practice Address - City:WALDRON
Practice Address - State:AR
Practice Address - Zip Code:72958-7455
Practice Address - Country:US
Practice Address - Phone:479-637-4197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD06208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist