Provider Demographics
NPI:1225112030
Name:SMITH, AMIRA REZK (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:AMIRA
Middle Name:REZK
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-2702
Mailing Address - Country:US
Mailing Address - Phone:662-728-1951
Mailing Address - Fax:662-728-1873
Practice Address - Street 1:206 N 2ND ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-2702
Practice Address - Country:US
Practice Address - Phone:662-728-1951
Practice Address - Fax:662-728-1873
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5871750001OtherMEDICARE DME
MS5871750001Medicare NSC