Provider Demographics
NPI:1114211745
Name:SMIT, JOHANNES DANIEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHANNES
Middle Name:DANIEL
Last Name:SMIT
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 1:525 VALLEYWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290
Mailing Address - Country:US
Mailing Address - Phone:770-487-4226
Mailing Address - Fax:678-364-1221
Practice Address - Street 1:525 VALLEYWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290
Practice Address - Country:US
Practice Address - Phone:770-487-4226
Practice Address - Fax:678-364-1221
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist