Provider Demographics
NPI:1093836744
Name:SMITH, CARLA G (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 NORTHBAY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9111
Mailing Address - Country:US
Mailing Address - Phone:601-853-9534
Mailing Address - Fax:
Practice Address - Street 1:300 NISSAN DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8562
Practice Address - Country:US
Practice Address - Phone:601-855-8600
Practice Address - Fax:601-855-8606
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE08258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist