Provider Demographics
NPI:1083098487
Name:SMITH, NICOLE YVETTE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:YVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28147-9007
Mailing Address - Country:US
Mailing Address - Phone:704-310-6229
Mailing Address - Fax:704-797-2364
Practice Address - Street 1:2110 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-9007
Practice Address - Country:US
Practice Address - Phone:704-310-6229
Practice Address - Fax:704-797-2364
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16517183500000X
VA0202211025183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist