Provider Demographics
NPI:1235595570
Name:SMART, ASHLEY I
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:SMART
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 BRUN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-6702
Mailing Address - Country:US
Mailing Address - Phone:972-489-1781
Mailing Address - Fax:
Practice Address - Street 1:2422 BRUN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-6702
Practice Address - Country:US
Practice Address - Phone:972-489-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55028183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist