Provider Demographics
NPI:1659782688
Name:SMITH, JENNIFER G (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 CLAIBORNE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4109
Mailing Address - Country:US
Mailing Address - Phone:318-342-1815
Mailing Address - Fax:318-632-2009
Practice Address - Street 1:1725 CLAIBORNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103
Practice Address - Country:US
Practice Address - Phone:318-342-1815
Practice Address - Fax:318-632-2009
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0192971835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy