Provider Demographics
NPI:1740210111
Name:SMITH, DALE EUGENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:EUGENE
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 1:1212 NE 96TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2149
Mailing Address - Country:US
Mailing Address - Phone:816-734-4536
Mailing Address - Fax:816-245-5702
Practice Address - Street 1:1575 N. UNIVERSAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64120
Practice Address - Country:US
Practice Address - Phone:816-245-5700
Practice Address - Fax:816-245-5702
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist