Provider Demographics
NPI:1184767956
Name:SMITH, STEVE W (RPH)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:W
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 1:10126 US HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31757-1109
Mailing Address - Country:US
Mailing Address - Phone:229-227-0075
Mailing Address - Fax:
Practice Address - Street 1:1245 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1633
Practice Address - Country:US
Practice Address - Phone:850-997-1707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0019847183500000X
GARPH012941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH012941OtherLICENSE NUMBER
FLPS0019847OtherLICENSE NUMBER