Provider Demographics
NPI:1568784106
Name:SMITH, JEREMY DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 NW BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130
Mailing Address - Country:US
Mailing Address - Phone:615-890-3323
Mailing Address - Fax:615-890-8619
Practice Address - Street 1:1266 NW BROAD ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1713
Practice Address - Country:US
Practice Address - Phone:615-890-3323
Practice Address - Fax:615-890-8619
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist