Provider Demographics
NPI:1275970626
Name:SMITH, DARWIN L
Entity Type:Individual
Prefix:MR
First Name:DARWIN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DARWIN
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:5080 SUMMERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5798
Mailing Address - Country:US
Mailing Address - Phone:231-578-4463
Mailing Address - Fax:
Practice Address - Street 1:18416 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2317
Practice Address - Country:US
Practice Address - Phone:313-397-2575
Practice Address - Fax:313-397-7572
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302026293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist