Provider Demographics
NPI:1184921009
Name:SMITH, DUSTIN JAMES (PHARM D)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5860
Mailing Address - Country:US
Mailing Address - Phone:405-793-1120
Mailing Address - Fax:405-793-9536
Practice Address - Street 1:1229 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5860
Practice Address - Country:US
Practice Address - Phone:405-793-1120
Practice Address - Fax:405-793-9536
Is Sole Proprietor?:No
Enumeration Date:2011-02-13
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49055183500000X
OK14778183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist