Provider Demographics
NPI:1164767448
Name:SMITH, CAROLYN ANN (RPH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ANN
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 1:403 RUTLEDGE CT
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5204
Mailing Address - Country:US
Mailing Address - Phone:419-874-1958
Mailing Address - Fax:
Practice Address - Street 1:6920 HALL ST STE 1
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9485
Practice Address - Country:US
Practice Address - Phone:855-729-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03115047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist