Provider Demographics
NPI:1710330410
Name:SMITH, DONALD R (RPH)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:R
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 1:9101 SISK LN LOT 11
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-2869
Mailing Address - Country:US
Mailing Address - Phone:817-808-6030
Mailing Address - Fax:
Practice Address - Street 1:351 CYPRESS CREEK RD
Practice Address - Street 2:STE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4528
Practice Address - Country:US
Practice Address - Phone:512-382-7393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist