Provider Demographics
NPI:1316535164
Name:SMITH, CASEY COLVARD (PHARMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:COLVARD
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:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:CHICKAMAUGA
Mailing Address - State:GA
Mailing Address - Zip Code:30707-0721
Mailing Address - Country:US
Mailing Address - Phone:706-956-5318
Mailing Address - Fax:706-956-5319
Practice Address - Street 1:357 LEE AND GORDON MILL RD
Practice Address - Street 2:
Practice Address - City:CHICKAMAUGA
Practice Address - State:GA
Practice Address - Zip Code:30707-1716
Practice Address - Country:US
Practice Address - Phone:706-956-5318
Practice Address - Fax:706-956-5319
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist