Provider Demographics
NPI:1518550417
Name:SMITH, DAVID BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRUCE
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 1:133 W HUNTING PARK AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2717
Mailing Address - Country:US
Mailing Address - Phone:215-324-5100
Mailing Address - Fax:215-324-5600
Practice Address - Street 1:133 W HUNTING PARK AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2717
Practice Address - Country:US
Practice Address - Phone:215-324-5100
Practice Address - Fax:215-324-5600
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031560L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist