Provider Demographics
NPI:1891096707
Name:SMITH, RICHARD BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BRUCE
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 1:152 ROOSEVELT AVE. E.
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022
Mailing Address - Country:US
Mailing Address - Phone:360-802-1534
Mailing Address - Fax:360-802-5251
Practice Address - Street 1:152 ROOSEVELT AVE. E.
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-8246
Practice Address - Country:US
Practice Address - Phone:360-802-1534
Practice Address - Fax:360-802-5251
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00009972183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist