Provider Demographics
NPI:1891350963
Name:SMITH, DYLAN JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAMES
Last Name:SMITH
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 1:122 CHOCTAW DRIVE
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-7885
Mailing Address - Country:US
Mailing Address - Phone:315-404-6901
Mailing Address - Fax:
Practice Address - Street 1:25 BURKE BLVD
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2478
Practice Address - Country:US
Practice Address - Phone:919-496-2541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065222183500000X
NC29980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist