Provider Demographics
NPI:1073505731
Name:SMITH, RICHARD LYNN (R PH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 S SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-8702
Mailing Address - Country:US
Mailing Address - Phone:229-246-1200
Mailing Address - Fax:229-243-8146
Practice Address - Street 1:823 S SCOTT ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-8702
Practice Address - Country:US
Practice Address - Phone:229-246-1200
Practice Address - Fax:229-243-8146
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13364OtherPHARMACIST
GA9601OtherPHARMACIST