Provider Demographics
NPI:1760763254
Name:SMITH, ROSS DAVIS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:DAVIS
Last Name:SMITH
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 1:8917 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73141-2245
Mailing Address - Country:US
Mailing Address - Phone:405-769-2712
Mailing Address - Fax:405-769-2946
Practice Address - Street 1:8917 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73141-2245
Practice Address - Country:US
Practice Address - Phone:405-769-2712
Practice Address - Fax:405-769-2946
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist