Provider Demographics
NPI:1518080183
Name:SMITH, DAVID M (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
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 1:545 2ND ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-1233
Mailing Address - Country:US
Mailing Address - Phone:716-745-7521
Mailing Address - Fax:
Practice Address - Street 1:2739 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2701
Practice Address - Country:US
Practice Address - Phone:716-871-1490
Practice Address - Fax:716-871-1496
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033566183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist