Provider Demographics
NPI:1730470873
Name:SMITH, CHERYL (RPH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SARATOGA RD
Mailing Address - Street 2:APT. D4
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4236
Mailing Address - Country:US
Mailing Address - Phone:802-355-7476
Mailing Address - Fax:
Practice Address - Street 1:82 VT ROUTE 15 W
Practice Address - Street 2:RITE AID PHARMACY
Practice Address - City:HARDWICK
Practice Address - State:VT
Practice Address - Zip Code:05843
Practice Address - Country:US
Practice Address - Phone:802-472-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-24
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT033-0002775183500000X
NY035049-1183500000X
FLPS-0032388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist