Provider Demographics
NPI:1649748799
Name:SMITH, KAYLIE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:MARIE
Last Name:SMITH
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 1:17757 US HIGHWAY 19 N STE 250
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6597
Mailing Address - Country:US
Mailing Address - Phone:727-519-1606
Mailing Address - Fax:
Practice Address - Street 1:17757 US HIGHWAY 19 N STE 250
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6597
Practice Address - Country:US
Practice Address - Phone:727-519-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist