Provider Demographics
NPI:1689991218
Name:SMITH, ESTHER
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19717 FLEETWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARPER WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48225-1667
Mailing Address - Country:US
Mailing Address - Phone:313-885-1401
Mailing Address - Fax:
Practice Address - Street 1:22315 MOROSS RD
Practice Address - Street 2:RITE AID BLDG
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2116
Practice Address - Country:US
Practice Address - Phone:313-885-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist