Provider Demographics
NPI:1881001113
Name:SMOOT, DAMIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:
Last Name:SMOOT
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 1:7503 PRINCE GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5715
Mailing Address - Country:US
Mailing Address - Phone:410-602-0379
Mailing Address - Fax:
Practice Address - Street 1:1013 WOODBRIDGE CENTER WAY
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-3836
Practice Address - Country:US
Practice Address - Phone:410-676-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist