Provider Demographics
NPI:1407298342
Name:SMITH, GARY CURTIS (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:CURTIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4807
Mailing Address - Country:US
Mailing Address - Phone:208-241-6333
Mailing Address - Fax:
Practice Address - Street 1:1275 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4807
Practice Address - Country:US
Practice Address - Phone:406-723-9408
Practice Address - Fax:406-723-8367
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist