Provider Demographics
NPI:1043737810
Name:SMITH, DEBORAH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21009 WILLS TRCE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5187
Mailing Address - Country:US
Mailing Address - Phone:662-607-8829
Mailing Address - Fax:
Practice Address - Street 1:905 N PONTOTOC ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-1516
Practice Address - Country:US
Practice Address - Phone:662-448-6011
Practice Address - Fax:662-448-6014
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist