Provider Demographics
NPI:1437465846
Name:SMITH, LISA W (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:W
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 1:199 OLD COURTHOUSE RD
Mailing Address - Street 2:PO BOX 2408
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-9853
Mailing Address - Country:US
Mailing Address - Phone:434-352-3784
Mailing Address - Fax:434-352-3717
Practice Address - Street 1:199 OLD COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522-9853
Practice Address - Country:US
Practice Address - Phone:434-352-3784
Practice Address - Fax:434-352-3717
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202010390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist