Provider Demographics
NPI:1194030486
Name:SMITH, CAROL SOUTHER (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SOUTHER
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 1:2255 E ANDREW JOHNSON HWY
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4375
Mailing Address - Country:US
Mailing Address - Phone:423-639-8631
Mailing Address - Fax:423-639-0302
Practice Address - Street 1:2255 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4375
Practice Address - Country:US
Practice Address - Phone:423-639-8631
Practice Address - Fax:423-639-0302
Is Sole Proprietor?:No
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist