Provider Demographics
NPI:1972851095
Name:SMITH, KEVIN MICHAEL (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:MICHAEL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1903 BROOKSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-1301
Mailing Address - Country:US
Mailing Address - Phone:423-390-1064
Mailing Address - Fax:423-390-2311
Practice Address - Street 1:1903 BROOKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4617
Practice Address - Country:US
Practice Address - Phone:423-390-1064
Practice Address - Fax:423-390-1123
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36768183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist