Provider Demographics
NPI:1720363302
Name:SMITH, DARON L (RPH)
Entity Type:Individual
Prefix:
First Name:DARON
Middle Name:L
Last Name:SMITH
Suffix:
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 1:1926 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1523
Mailing Address - Country:US
Mailing Address - Phone:314-306-5109
Mailing Address - Fax:314-644-0924
Practice Address - Street 1:2340 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2935
Practice Address - Country:US
Practice Address - Phone:314-647-1256
Practice Address - Fax:314-644-0924
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist