Provider Demographics
NPI:1699810648
Name:SMITH, KEVIN MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:MICHAEL
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 1:16 CHELSEA FARM DR
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:RI
Mailing Address - Zip Code:02898-1221
Mailing Address - Country:US
Mailing Address - Phone:401-539-8444
Mailing Address - Fax:
Practice Address - Street 1:16 CHELSEA FARM DR
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:RI
Practice Address - Zip Code:02898-1221
Practice Address - Country:US
Practice Address - Phone:401-539-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH03870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist