Provider Demographics
NPI:1891864716
Name:SMITH, JENNIFER MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:CHRISTIANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:200 RALEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-0002
Mailing Address - Country:US
Mailing Address - Phone:304-461-1200
Mailing Address - Fax:304-461-1201
Practice Address - Street 1:200 RALEIGH AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-0002
Practice Address - Country:US
Practice Address - Phone:304-461-1200
Practice Address - Fax:304-461-1201
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0005924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5000310OtherNABP