Provider Demographics
NPI:1043432214
Name:SMITH, MICHAEL EARL (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EARL
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 1:2220 W PARK ROW DR STE A
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3487
Mailing Address - Country:US
Mailing Address - Phone:817-274-0050
Mailing Address - Fax:
Practice Address - Street 1:2220 W PARK ROW DR STE A
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-3487
Practice Address - Country:US
Practice Address - Phone:817-274-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22382183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist