Provider Demographics
NPI:1689278889
Name:SMITH, CHAD
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45656-1268
Mailing Address - Country:US
Mailing Address - Phone:740-682-3525
Mailing Address - Fax:740-682-6917
Practice Address - Street 1:407 N FRONT ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:OH
Practice Address - Zip Code:45656-1268
Practice Address - Country:US
Practice Address - Phone:740-682-3525
Practice Address - Fax:740-682-6917
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH22721183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist