Provider Demographics
NPI:1497206346
Name:SMITH, NANCY ELIZABETH (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
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 1:1590 BABY BEAR RD
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-8901
Mailing Address - Country:US
Mailing Address - Phone:520-678-6565
Mailing Address - Fax:
Practice Address - Street 1:201 S PRICKLY PEAR AVE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6446
Practice Address - Country:US
Practice Address - Phone:520-586-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-16
Last Update Date:2016-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018804183500000X
CO15723183500000X
IDP4677183500000X
NM7927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7927OtherREGISTERED PHARMACIST
IDP4677OtherREGISTERED PHARMACIST
CO15723OtherREGISTERED PHARMACIST
AZS018804OtherREGISTERED PHARMACIST