Provider Demographics
NPI:1043321557
Name:SMOOTS, GREG LEE (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:LEE
Last Name:SMOOTS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 BURDEN TER
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5710
Mailing Address - Country:US
Mailing Address - Phone:530-533-3103
Mailing Address - Fax:530-533-9014
Practice Address - Street 1:3010 MYERS ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5940
Practice Address - Country:US
Practice Address - Phone:530-533-3103
Practice Address - Fax:530-533-9014
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH44925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist