Provider Demographics
NPI:1891181384
Name:SMITH, ELIZABETH KAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2955
Mailing Address - Country:US
Mailing Address - Phone:870-508-1377
Mailing Address - Fax:870-508-1315
Practice Address - Street 1:9746 HIGHWAY 62/412
Practice Address - Street 2:
Practice Address - City:VIOLA
Practice Address - State:AR
Practice Address - Zip Code:72583
Practice Address - Country:US
Practice Address - Phone:870-900-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14180183500000X
TX58171183500000X
ARPD13928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist