Provider Demographics
NPI:1629167523
Name:SMITH, JENNIFER MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 AIRPORT COMMERCE DRIVE
Mailing Address - Street 2:BUILDING 3, SUITE 350
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741
Mailing Address - Country:US
Mailing Address - Phone:512-628-8877
Mailing Address - Fax:512-628-8878
Practice Address - Street 1:1340 AIRPORT COMMERCE DR
Practice Address - Street 2:BUILDING 3, SUITE 350
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6831
Practice Address - Country:US
Practice Address - Phone:512-628-8877
Practice Address - Fax:512-628-8878
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX427241835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy