Provider Demographics
NPI:1114680717
Name:SMITH, TIMOTHY KALEB (PHARMD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KALEB
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 APPLE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMER SHADE
Mailing Address - State:KY
Mailing Address - Zip Code:42166-7687
Mailing Address - Country:US
Mailing Address - Phone:270-427-1193
Mailing Address - Fax:
Practice Address - Street 1:651 BROWN ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TN
Practice Address - Zip Code:38551-4019
Practice Address - Country:US
Practice Address - Phone:270-427-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20349183500000X
KY021330183500000X
TN44086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist