Provider Demographics
NPI:1346569621
Name:SMITH, TZENA MARIA (RPH, SCD)
Entity Type:Individual
Prefix:DR
First Name:TZENA
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH, SCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-6304
Mailing Address - Country:US
Mailing Address - Phone:734-482-7430
Mailing Address - Fax:734-480-1353
Practice Address - Street 1:753 S GROVE ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-6304
Practice Address - Country:US
Practice Address - Phone:734-482-7430
Practice Address - Fax:734-480-1353
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist