Provider Demographics
NPI:1629379623
Name:SMILEY, WAYNE LEROY (RPH)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:LEROY
Last Name:SMILEY
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 1:801 REID RD
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-8759
Mailing Address - Country:US
Mailing Address - Phone:509-334-5549
Mailing Address - Fax:
Practice Address - Street 1:1320 S BLAINE ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3971
Practice Address - Country:US
Practice Address - Phone:208-882-2663
Practice Address - Fax:208-882-0297
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5208183500000X
WAPH00019086183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist