Provider Demographics
NPI:1891027066
Name:SMITH, KEITH JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4290 W VIENNA RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-9454
Mailing Address - Country:US
Mailing Address - Phone:810-564-9351
Mailing Address - Fax:810-564-9354
Practice Address - Street 1:4290 W VIENNA RD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-9454
Practice Address - Country:US
Practice Address - Phone:810-564-9351
Practice Address - Fax:810-564-9354
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist