Provider Demographics
NPI:1184975914
Name:SMITH, PAULA R (RPH)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:R
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 1:4012 TEAYS VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9760
Mailing Address - Country:US
Mailing Address - Phone:304-201-1630
Mailing Address - Fax:304-201-1635
Practice Address - Street 1:4012 TEAYS VALLEY RD
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9760
Practice Address - Country:US
Practice Address - Phone:304-201-1630
Practice Address - Fax:304-201-1635
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3838183500000X
VA5050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist