Provider Demographics
NPI:1043337397
Name:SMITH, MARK WOOD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:WOOD
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 1:2534 ZACHARY WOODS DR NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1892
Mailing Address - Country:US
Mailing Address - Phone:770-794-8133
Mailing Address - Fax:
Practice Address - Street 1:731 WHITLOCK AVE SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-3033
Practice Address - Country:US
Practice Address - Phone:770-427-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0139971835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy