Provider Demographics
NPI:1639806144
Name:SMITH, JARROD MALCOLM (PHARMD)
Entity Type:Individual
Prefix:
First Name:JARROD
Middle Name:MALCOLM
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 1:1702 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-1117
Mailing Address - Country:US
Mailing Address - Phone:785-215-7730
Mailing Address - Fax:
Practice Address - Street 1:628 MADISON ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1338
Practice Address - Country:US
Practice Address - Phone:620-378-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-107262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist