Provider Demographics
NPI:1629679469
Name:SMITH-KAMINSKY, LORI (PHARMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SMITH-KAMINSKY
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 1:13790 STATE ROAD 23
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7558
Mailing Address - Country:US
Mailing Address - Phone:574-855-4865
Mailing Address - Fax:
Practice Address - Street 1:700 W IRELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-3810
Practice Address - Country:US
Practice Address - Phone:574-299-1464
Practice Address - Fax:574-299-1467
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59714183500000X
IN26023069A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist