Provider Demographics
NPI:1598270761
Name:SMART, DANIEL LANE (DPH)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LANE
Last Name:SMART
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N J M DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-6811
Mailing Address - Country:US
Mailing Address - Phone:918-341-4938
Mailing Address - Fax:918-341-4971
Practice Address - Street 1:100 N J M DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-6811
Practice Address - Country:US
Practice Address - Phone:918-341-4938
Practice Address - Fax:918-341-4971
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-09
Last Update Date:2017-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9401183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist