Provider Demographics
NPI:1497774269
Name:SMITH, JONALAN DUANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JONALAN
Middle Name:DUANE
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 1:5809 ALHAMBRA ST
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-3156
Mailing Address - Country:US
Mailing Address - Phone:785-840-7007
Mailing Address - Fax:
Practice Address - Street 1:5809 ALHAMBRA ST
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-3156
Practice Address - Country:US
Practice Address - Phone:785-840-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14263183500000X
MO2007021861183500000X
DCPH100000376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1-14263OtherSTATE BOARD OF PHARMACY