Provider Demographics
NPI:1497196067
Name:SMITH, NATHAN DALE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:DALE
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 1:522 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OH
Mailing Address - Zip Code:45768-9784
Mailing Address - Country:US
Mailing Address - Phone:304-588-1186
Mailing Address - Fax:
Practice Address - Street 1:405 FAIRMONT RD
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-4227
Practice Address - Country:US
Practice Address - Phone:304-295-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist