Provider Demographics
NPI:1417271594
Name:SMITH, DONNA MARIE
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 HORSEBLOCK RD
Mailing Address - Street 2:TARGET PHARMACY T-1948
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2526
Mailing Address - Country:US
Mailing Address - Phone:631-286-1854
Mailing Address - Fax:
Practice Address - Street 1:2975 HORSEBLOCK RD
Practice Address - Street 2:TARGET PHARMACY T-1948
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2526
Practice Address - Country:US
Practice Address - Phone:631-286-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist