Provider Demographics
NPI:1760085609
Name:SMYTH, NICHOLAUS (PHARMD)
Entity Type:Individual
Prefix:
First Name:NICHOLAUS
Middle Name:
Last Name:SMYTH
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 1:7608 MOUNTAIN GROVE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6755
Mailing Address - Country:US
Mailing Address - Phone:865-573-5090
Mailing Address - Fax:
Practice Address - Street 1:7608 MOUNTAIN GROVE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6755
Practice Address - Country:US
Practice Address - Phone:865-573-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39704183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist