Provider Demographics
NPI:1639764111
Name:SMITH, ALISHA (PHARM D)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 E NEW BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:NASH
Mailing Address - State:TX
Mailing Address - Zip Code:75569-2715
Mailing Address - Country:US
Mailing Address - Phone:833-569-1005
Mailing Address - Fax:
Practice Address - Street 1:459 E NEW BOSTON RD
Practice Address - Street 2:
Practice Address - City:NASH
Practice Address - State:TX
Practice Address - Zip Code:75569-2715
Practice Address - Country:US
Practice Address - Phone:338-569-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX41921OtherSTATE BOARD REGISTRY