Provider Demographics
NPI:1417298563
Name:SMITH, GRACEMARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:GRACEMARIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8028 RITCHIE HWY STE 314
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1360
Mailing Address - Country:US
Mailing Address - Phone:410-553-2413
Mailing Address - Fax:410-553-2427
Practice Address - Street 1:8028 RITCHIE HWY STE 314
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1360
Practice Address - Country:US
Practice Address - Phone:410-553-2413
Practice Address - Fax:410-553-2427
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11818183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist