Provider Demographics
NPI:1912181355
Name:SMITH, ARTHUR R (RPH)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:R
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 1:29 LEA DR
Mailing Address - Street 2:
Mailing Address - City:DELANSON
Mailing Address - State:NY
Mailing Address - Zip Code:12053-3551
Mailing Address - Country:US
Mailing Address - Phone:518-669-2832
Mailing Address - Fax:518-875-9056
Practice Address - Street 1:428 BALLTOWN RD
Practice Address - Street 2:TARGET PHARMACY
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2245
Practice Address - Country:US
Practice Address - Phone:518-346-8670
Practice Address - Fax:518-346-8670
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0292-1924Medicaid