Provider Demographics
NPI:1205255429
Name:SMOCK, DOUGLAS BRYAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:BRYAN
Last Name:SMOCK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3313 ESSEX DRIVE
Mailing Address - Street 2:STE 200
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082
Mailing Address - Country:US
Mailing Address - Phone:214-765-5457
Mailing Address - Fax:214-765-5477
Practice Address - Street 1:3313 ESSEX DRIVE
Practice Address - Street 2:STE 200
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082
Practice Address - Country:US
Practice Address - Phone:214-765-5457
Practice Address - Fax:214-765-5477
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX483451835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric