Provider Demographics
NPI:1134319874
Name:SMITH, DOUG (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DOUG
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-0406
Mailing Address - Country:US
Mailing Address - Phone:865-828-5222
Mailing Address - Fax:865-828-5959
Practice Address - Street 1:8120 RUTLEDGE PIKE
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-0406
Practice Address - Country:US
Practice Address - Phone:865-828-5222
Practice Address - Fax:865-828-5959
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2924OtherSTATE LISCENSE NUMBER