Provider Demographics
NPI:1184267403
Name:SMITH, PATRICK
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 WABASH AVE N
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44613-1042
Mailing Address - Country:US
Mailing Address - Phone:330-767-3436
Mailing Address - Fax:
Practice Address - Street 1:360 WABASH AVE N
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:OH
Practice Address - Zip Code:44613-1042
Practice Address - Country:US
Practice Address - Phone:330-767-3436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03117533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist