Provider Demographics
NPI:1134340466
Name:SMITH, JAN T (RPH)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:T
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 1:1757 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2030
Mailing Address - Country:US
Mailing Address - Phone:770-532-9094
Mailing Address - Fax:
Practice Address - Street 1:200 CRESCENT CENTER PKWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7047
Practice Address - Country:US
Practice Address - Phone:770-496-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist