Provider Demographics
NPI:1508533241
Name:SMITH, LANCER PARKS (RPH)
Entity Type:Individual
Prefix:MR
First Name:LANCER
Middle Name:PARKS
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8985 MOFFETT RD
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-5311
Mailing Address - Country:US
Mailing Address - Phone:251-645-7979
Mailing Address - Fax:251-645-9008
Practice Address - Street 1:8985 MOFFETT RD
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-5311
Practice Address - Country:US
Practice Address - Phone:251-645-7979
Practice Address - Fax:251-645-9008
Is Sole Proprietor?:No
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12417OtherALABAMA STATE LICENSE NUMBER