Provider Demographics
NPI:1508114588
Name:HENRIQUEZ-SMITH, CARLOTTA CHAYA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CARLOTTA
Middle Name:CHAYA
Last Name:HENRIQUEZ-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 1:3402 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1136
Mailing Address - Country:US
Mailing Address - Phone:216-961-9414
Mailing Address - Fax:216-651-8205
Practice Address - Street 1:3402 CLARK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1136
Practice Address - Country:US
Practice Address - Phone:216-961-9414
Practice Address - Fax:216-651-8205
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist