Provider Demographics
NPI:1497123731
Name:SMITH, MILLIE LYNN (PHARMD)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 BARDSTOWN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1513
Mailing Address - Country:US
Mailing Address - Phone:859-336-9004
Mailing Address - Fax:
Practice Address - Street 1:805 BARDSTOWN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1513
Practice Address - Country:US
Practice Address - Phone:859-336-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY018057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist