Provider Demographics
NPI:1073613543
Name:SMITH, MICHAEL LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
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 1:187 HICKORY LANE
Mailing Address - Street 2:
Mailing Address - City:CECIL
Mailing Address - State:AL
Mailing Address - Zip Code:36013
Mailing Address - Country:US
Mailing Address - Phone:334-409-9164
Mailing Address - Fax:334-409-9164
Practice Address - Street 1:7946 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-272-1510
Practice Address - Fax:334-272-1751
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist