Provider Demographics
NPI:1194833251
Name:SMITH, KEN B (RPH)
Entity Type:Individual
Prefix:
First Name:KEN
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4635 BARTON SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-7710
Mailing Address - Country:US
Mailing Address - Phone:423-581-0654
Mailing Address - Fax:423-733-2140
Practice Address - Street 1:140 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869
Practice Address - Country:US
Practice Address - Phone:423-733-2322
Practice Address - Fax:423-733-2140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist