Provider Demographics
NPI:1326051442
Name:SMITH, VANESSA NEVILLS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:NEVILLS
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:SHARON
Other - Last Name:NEVILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1205 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5649
Mailing Address - Country:US
Mailing Address - Phone:903-247-8262
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE
Practice Address - Street 2:OVERTON BROOK-VA HOSPITAL
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:903-247-8262
Practice Address - Fax:903-247-8273
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14772183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist