Provider Demographics
NPI:1326415944
Name:SMITH, ERIC WANE (PHD, RPH)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WANE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PARK PLACE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6690
Mailing Address - Country:US
Mailing Address - Phone:803-808-0688
Mailing Address - Fax:803-808-0698
Practice Address - Street 1:125 PARK PLACE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6690
Practice Address - Country:US
Practice Address - Phone:803-808-0688
Practice Address - Fax:803-808-0698
Is Sole Proprietor?:No
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11930183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC11930OtherSC BOARD OF PHARMACY - PHARMACIST LICENSE