Provider Demographics
NPI:1699860478
Name:SMITH, JAMES EDWIN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWIN
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:137 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-9449
Mailing Address - Country:US
Mailing Address - Phone:912-265-0290
Mailing Address - Fax:
Practice Address - Street 1:3045 SCARLETT ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-1251
Practice Address - Country:US
Practice Address - Phone:912-554-8469
Practice Address - Fax:912-280-1536
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH010449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist