Provider Demographics
NPI:1306356647
Name:SMITH, RAE CHRISTY (PHARMD)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:CHRISTY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 FAIRVIEW AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-1420
Mailing Address - Country:US
Mailing Address - Phone:410-340-4637
Mailing Address - Fax:
Practice Address - Street 1:6721 CHESAPEAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-6572
Practice Address - Country:US
Practice Address - Phone:410-863-1285
Practice Address - Fax:410-863-1287
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-30
Last Update Date:2017-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD22825OtherPHARMACY LICENSE NUMBER