Provider Demographics
NPI:1205381779
Name:SMITH, JOSHUA TAKESHI (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TAKESHI
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 1:8419 CHENIN BLANC LN
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1412
Mailing Address - Country:US
Mailing Address - Phone:408-460-0224
Mailing Address - Fax:
Practice Address - Street 1:8419 CHENIN BLANC LN
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1412
Practice Address - Country:US
Practice Address - Phone:408-460-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA74944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist