Provider Demographics
NPI:1467034918
Name:SMITH, JUSTIN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 EPHESUS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:REGISTER
Mailing Address - State:GA
Mailing Address - Zip Code:30452-4642
Mailing Address - Country:US
Mailing Address - Phone:912-334-1553
Mailing Address - Fax:
Practice Address - Street 1:10530 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1140
Practice Address - Country:US
Practice Address - Phone:912-712-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032657183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist