Provider Demographics
NPI:1851977177
Name:SMITH, ROBERT ALLEN
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 HELFORD LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8329
Mailing Address - Country:US
Mailing Address - Phone:317-439-6034
Mailing Address - Fax:
Practice Address - Street 1:1286 HELFORD LN
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8329
Practice Address - Country:US
Practice Address - Phone:317-439-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022334A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist