Provider Demographics
NPI:1881683621
Name:SMITH, HENRY R JR (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:R
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ROYALL AVE
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4746
Mailing Address - Country:US
Mailing Address - Phone:843-884-7668
Mailing Address - Fax:843-792-5198
Practice Address - Street 1:169 ASHLEY AVE
Practice Address - Street 2:ROOM 149 MUSC
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5836
Practice Address - Country:US
Practice Address - Phone:843-792-5220
Practice Address - Fax:843-792-5198
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist