Provider Demographics
NPI:1790385128
Name:SMITH, RAYMOND ARTHUR (PHARMD, PHD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:ARTHUR
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 CHAUTAUQUA ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4214
Mailing Address - Country:US
Mailing Address - Phone:715-735-9984
Mailing Address - Fax:
Practice Address - Street 1:2900 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4299
Practice Address - Country:US
Practice Address - Phone:715-735-5593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13848-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist