Provider Demographics
NPI:1275656738
Name:SMITH, ELIZABETH MITCHELL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MITCHELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 FOX HILL PL
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-1865
Mailing Address - Country:US
Mailing Address - Phone:804-541-1622
Mailing Address - Fax:
Practice Address - Street 1:3330 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9277
Practice Address - Country:US
Practice Address - Phone:804-863-1394
Practice Address - Fax:804-863-1903
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist