Provider Demographics
NPI:1033401724
Name:SMITH, NORMAN ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 SAINT NICK DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-5133
Mailing Address - Country:US
Mailing Address - Phone:504-210-6653
Mailing Address - Fax:
Practice Address - Street 1:109 N CLEVELAND AVE
Practice Address - Street 2:WINN-DIXIE PHARMACY
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4713
Practice Address - Country:US
Practice Address - Phone:228-863-0631
Practice Address - Fax:228-863-9174
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11907183500000X
MST-010867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist