Provider Demographics
NPI:1689028219
Name:SMITH, CARL DEAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:DEAN
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 1:310 FLEMING AVE
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-1406
Mailing Address - Country:US
Mailing Address - Phone:712-388-8872
Mailing Address - Fax:
Practice Address - Street 1:310 FLEMING AVE
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-1406
Practice Address - Country:US
Practice Address - Phone:712-388-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21088183500000X
NE13237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist