Provider Demographics
NPI:1730456823
Name:SMITH, AMBER L (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:SPOONER
Mailing Address - State:WI
Mailing Address - Zip Code:54801
Mailing Address - Country:US
Mailing Address - Phone:715-635-2117
Mailing Address - Fax:715-635-8135
Practice Address - Street 1:146 WALNUT STREET
Practice Address - Street 2:
Practice Address - City:SPOONER
Practice Address - State:WI
Practice Address - Zip Code:54801
Practice Address - Country:US
Practice Address - Phone:715-635-2117
Practice Address - Fax:715-635-8135
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119944183500000X
WI15519-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist