Provider Demographics
NPI:1235739889
Name:SMITH, MARIANNE
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:
Last Name:SMITH
Suffix:
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 1:27 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-1425
Mailing Address - Country:US
Mailing Address - Phone:864-472-2136
Mailing Address - Fax:864-472-2178
Practice Address - Street 1:27 N MAIN ST
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-1425
Practice Address - Country:US
Practice Address - Phone:864-472-2136
Practice Address - Fax:864-472-2178
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC009620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist