Provider Demographics
NPI:1437420247
Name:SMITH, LORAINE (RPH)
Entity Type:Individual
Prefix:
First Name:LORAINE
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 1:3321 SMILEY HONEA RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:MS
Mailing Address - Zip Code:39652-7701
Mailing Address - Country:US
Mailing Address - Phone:503-839-2141
Mailing Address - Fax:
Practice Address - Street 1:3321 SMILEY HONEA RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:MS
Practice Address - Zip Code:39652-7701
Practice Address - Country:US
Practice Address - Phone:503-839-2141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST010631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist