Provider Demographics
NPI:1407493505
Name:SMITH, JOHN DOYLE (RPH)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DOYLE
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:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0316
Mailing Address - Country:US
Mailing Address - Phone:817-771-1144
Mailing Address - Fax:
Practice Address - Street 1:601 PALO PINTO ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4129
Practice Address - Country:US
Practice Address - Phone:817-596-4165
Practice Address - Fax:866-547-6720
Is Sole Proprietor?:No
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21835183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist