Provider Demographics
NPI:1679697049
Name:SMITH, DAVID NOEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NOEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 N MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-3056
Mailing Address - Country:US
Mailing Address - Phone:360-434-6357
Mailing Address - Fax:
Practice Address - Street 1:616 6TH ST
Practice Address - Street 2:SUITE 960
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1420
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:360-479-0038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00014330183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist