Provider Demographics
NPI:1710518634
Name:SMITH, JAIRUS JAMES MATTHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAIRUS
Middle Name:JAMES MATTHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 COUNTRY CLUB RD APT 1315
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-6050
Mailing Address - Country:US
Mailing Address - Phone:337-578-8786
Mailing Address - Fax:
Practice Address - Street 1:4097 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2819
Practice Address - Country:US
Practice Address - Phone:337-474-0434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.023262183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist