Provider Demographics
NPI:1235633603
Name:SMITH, JOEY N (RPH)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:N
Last Name:SMITH
Suffix:
Gender:M
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:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:VAN
Mailing Address - State:WV
Mailing Address - Zip Code:25206-0450
Mailing Address - Country:US
Mailing Address - Phone:304-245-8255
Mailing Address - Fax:
Practice Address - Street 1:19024 POKND FORK RD
Practice Address - Street 2:
Practice Address - City:VAN
Practice Address - State:WV
Practice Address - Zip Code:25206
Practice Address - Country:US
Practice Address - Phone:304-245-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0005042OtherWV BOARD OF PHARMACY