Provider Demographics
NPI:1598777328
Name:SMITH, WALDEN R JR (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:WALDEN
Middle Name:R
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
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Mailing Address - Street 1:7500 NICOLE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5705
Mailing Address - Country:US
Mailing Address - Phone:502-491-7391
Mailing Address - Fax:502-287-6967
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-4594
Practice Address - Fax:502-287-6967
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY8405183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy