Provider Demographics
NPI:1366833154
Name:SMITH, MARK JAMES (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 ONEIDA ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6332
Mailing Address - Country:US
Mailing Address - Phone:315-601-4410
Mailing Address - Fax:
Practice Address - Street 1:2627 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6332
Practice Address - Country:US
Practice Address - Phone:315-601-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist