Provider Demographics
NPI:1942610779
Name:SMITH, PAMELA A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27320 SELKIRK ST
Mailing Address - Street 2:SOUTHFIELD
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3623
Mailing Address - Country:US
Mailing Address - Phone:586-573-2910
Mailing Address - Fax:
Practice Address - Street 1:29505 MOUND RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2012
Practice Address - Country:US
Practice Address - Phone:586-573-2910
Practice Address - Fax:586-573-2965
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53024111071835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy