Provider Demographics
NPI:1043626351
Name:SMITH, PHILIP JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JAMES
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 1:580 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1129
Mailing Address - Country:US
Mailing Address - Phone:989-277-0559
Mailing Address - Fax:
Practice Address - Street 1:2591 E M-21
Practice Address - Street 2:
Practice Address - City:CORONNA
Practice Address - State:MI
Practice Address - Zip Code:48817
Practice Address - Country:US
Practice Address - Phone:989-743-2533
Practice Address - Fax:989-743-2523
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist