Provider Demographics
NPI:1508155094
Name:SMITH, ELAINE L (RPH)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:L
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 1:1712 ALDEN LN
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1165
Mailing Address - Country:US
Mailing Address - Phone:610-670-2364
Mailing Address - Fax:
Practice Address - Street 1:1712 ALDEN LN
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1165
Practice Address - Country:US
Practice Address - Phone:610-670-2364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039998L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist