Provider Demographics
NPI:1356077408
Name:SMITH, RORY HAL
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:HAL
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3660
Mailing Address - Country:US
Mailing Address - Phone:435-586-7578
Mailing Address - Fax:435-267-1500
Practice Address - Street 1:755 S MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3660
Practice Address - Country:US
Practice Address - Phone:435-586-7578
Practice Address - Fax:435-267-1500
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT500585-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist