Provider Demographics
NPI:1295021582
Name:SMITH, DANIEL LEE (RPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
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 1:8235 SW WILSONVILLE RD
Mailing Address - Street 2:WILSONVILLE TOWN CENTER
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-7718
Mailing Address - Country:US
Mailing Address - Phone:503-682-2701
Mailing Address - Fax:
Practice Address - Street 1:8235 SW WILSONVILLE RD
Practice Address - Street 2:WILSONVILLE TOWN CENTER
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7718
Practice Address - Country:US
Practice Address - Phone:503-682-2701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6781183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist