Provider Demographics
NPI:1629678438
Name:SMITH, DAVID B (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
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 1:369 SCOTTS FORK-BONNIE ROAD
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601
Mailing Address - Country:US
Mailing Address - Phone:304-689-3006
Mailing Address - Fax:304-689-3005
Practice Address - Street 1:369 SCOTTS FORK-BONNIE ROAD
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601
Practice Address - Country:US
Practice Address - Phone:304-689-3006
Practice Address - Fax:304-689-3005
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0008597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist